Mandatory Laparotomy in Penetrating Abdominal Injuries with Omental Evisceration: Experience in a Major Trauma Center in the Philippines

Abstract

Background: Omental evisceration due to abdominal stab injuries connotes peritoneal penetration and translates to around 70% risk of intra-abdominal injury. Such cases are being managed with mandatory laparotomy at the Philippine General Hospital. This study aims to review the patient profile and laparotomy outcomes in such cases.Methods: This is a retrospective review of 98 consecutive laparotomies performed for patients with omental evisceration secondary to abdominal stab wounds between January 2004 to April 2018.Results: Almost all patients were male (99%) with a mean age of 32.1 years (range 14-70). The majority (81%) had a therapeutic laparotomy, and only 19 patients (19%) had a non-therapeutic laparotomy. The most commonly injured organs include the small bowel, stomach, colon, diaphragm, and liver. There was no significant difference in age, sex, duration of injury, systolic blood pressure and heart rate at presentation between the two groups. There were significantly more patients who presented with peritonism in the therapeutic laparotomy group compared to the non-therapeutic laparotomy group (82% vs 53%, p=0.005). Patients who presented with peritonism were six times more likely to have a therapeutic laparotomy. There was no significant difference between morbidity and mortality rates in the two groups. The length of hospital stay for the non-therapeutic laparotomy group was significantly shorter compared to the therapeutic laparotomy group (3.6 vs 5.7 days, p=0.006).Conclusion: The rate of therapeutic laparotomy remains to be significantly higher among patients with omental evisceration. Hence, omental evisceration, particularly those associated with peritonism, should continue to prompt operative management.

Penetrating Abdominal Trauma in Children: A Tertiary Hospital Experience in a Developing Country

“…This late presentation may be due to poverty and ignorance that is prevalent in developing countries. The average length of time the patients stayed in the hospital in the current study is comparable to the reports of Chalya et al but unsupported by the works of De Robles [14,15]. The duration of time a patient stays in the hospital may depend on the age of the patient, severity of injury and extent of the surgical procedure performed [16].…”

Penetrating abdominal trauma: an experience at tertiary care centres

“…Omental or organ evisceration has been associated with intra abdominal injuries in 68%-75% of the cases (1). This association has been responsible for the formulation of exploratory laparotomy being accepted as the standard line of management for such cases (2). The association is stronger with the evisceration of organs than with omentum alone3.…”