Laparotomy for Abdominal Stab Wound With Combined Omental and Organ Evisceration: 10-Year Experience From a Major Trauma Centre in South Africa

Abstract

Introduction Combined omental and organ evisceration following anterior abdominal stab wound (SW) is uncommon and there is a paucity of literature describing the management and spectrum of injuries encountered at laparotomy. Methods A retrospective study was undertaken on all patients who presented with anterior abdominal SW involving combined omental and organ evisceration who underwent laparotomy over a 10-year period from January 2008 to January 2018 at a major trauma centre in South Africa. Results A total of 61 patients were eligible for inclusion and all underwent laparotomy: 87% male, mean age: 29 years. Ninety-two percent (56/61) had a positive laparotomy whilst 8% (5/61) underwent a negative procedure. Of the 56 positive laparotomies, 91% (51/56) were considered therapeutic and 9% (5/56) were non-therapeutic. In addition to omental evisceration, 59% (36/61) had eviscerated small bowel, 28% (17/61) had eviscerated colon and 13% (8/61) had eviscerated stomach. A total of 92 organ injuries were identified. The most commonly injured organs were small bowel, large bowel and stomach. The overall complication rate was 11%. Twelve percent (7/61) required intensive care unit admission. The mean length of hospital stay was 9 days. The overall mortality rate for all 61 patients was 2%. Conclusions The presence of combined omental and organ evisceration following abdominal SW mandates laparotomy. The small bowel, large bowel and stomach were the most commonly injured organs in this setting.

Potential Spectrum of Accompanied Penetrating Abdominal Intraperitoneal Injuries with Bowel Evisceration: Surprises Awaiting the Trauma Surgeon in Resource Limited Settings

“…Care should be taken as medication may affect blood pressure values with patients with higher pain threshold withstanding clinical signs and symptoms of peritonitis [ 7 ]. However, there is a high incidence of intraperitoneal viscera injury with patients presenting with bowels eviscerations thus mandating exploration [ 8 , 9 , 19 , 21 , 22 ]. This was the observation in all the four cases presented as all had intraperitoneal organs eviscerations and had accompanying viscera injuries which needed therapeutic surgical repair (Figures 1 – 4 ).…”

“…He had sustained anterior abdominal wall umbilical area broken beer bottle stab wound. However combined omental and viscera evisceration post anterior abdominal stab wound is uncommon [ 9 ]. Prognosis of intraperitoneal injuries depends on extent of trauma, time of presentation, intestinal contents peritoneal cavity contamination, haemorrhage, wide spectrum of organ injury, female sex [ 5 ], accompanying brain trauma, or bleeding disorders increases the mortality rate [ 4 ].…”

“…Stab wounds are more common but with low mortality rates [6,7]. Male predominance is seen in penetrating abdominal injuries [2,3,[8][9][10]. The violation of abdominal cavity results in the small bowel (50%), large bowel (40%), liver (30%), and intraabdominal vasculature (25%) constituting the higher spectrum percentage of intraperitoneal viscera injury [4].…”

Potential spectrum of accompanied penetrating abdominal intra-peritoneal injuries with bowel evisceration: Surprises awaiting the trauma Surgeon in resource limited settings.

“…However for patients who are haemodynamically stable, with no signs of peritonism and have been evaluated with triple contrast CT scan, laparotomy maybe withheld and observed (5) (11) . Care should be taken as medication may affect blood pressure values with patients with higher pain threshold withstanding clinical signs and symptoms of peritonitis (7) .However there is a high incidence of intra-peritoneal viscera injury with patients presenting with bowels eviscerations thus mandating exploration (12)(13)(14)(15) (9) . This was the observation in all the four cases presented as all had intra-peritoneal organs eviscerations and had accompanying viscera injuries which needed theraupetic surgical repair (Fig.…”

“…He had sustained anterior abdominal wall umbilical area broken beer bottle stab wound. However combined omental and viscera evisceration post anterior abdominal stab wound is uncommon (9) . Prognosis of intra-peritoneal injuries depends on extent of trauma, time of presentation, intestinal contents peritoneal cavity contamination, haemorrhage, wide spectrum of organ injury, female sex (5) , accompanying brain trauma, or bleeding disorders increases the mortality rate (4) .…”