Evisceration after abdominal stab wounds: is laparotomy required?
OBJECTIVE
To determine the incidence of intra-abdominal injury requiring laparotomy after an abdominal stab wound with evisceration. To identify clinical signs that increase the likelihood of an intra-abdominal injury in the presence of such a wound.


METHODS
Information was collected prospectively over an 8-year period on all patients who presented to our urban level I trauma center with an abdominal stab wound and evisceration. This information included which organ eviscerated, presence of other indications for laparotomy, organs injured, and postoperative complications. All comparisons used the Fisher's exact chi2.


RESULTS
A total of 81 patients were admitted with evisceration after an abdominal stab wound. Sixty-one patients (75%) had eviscerated omentum, 18 patients (22%) had eviscerated small bowel, and 2 patients (2%) had eviscerated colon. Sixty-two patients (76%) had evisceration as the sole indication for laparotomy, the remaining 19 patients (24%) had another indication such as hypotension or peritonitis. Overall, 63 patients (78%) had an intra-abdominal injury that required repair. This was true regardless of organ eviscerated (omentum = 77% vs. viscus = 80%, not significant) or clinical presentation (no other indication = 76% vs. another indication = 84%, not significant).


CONCLUSIONS
The majority of patients who present with an evisceration after a stab wound to the abdomen require a laparotomy. This is true regardless of what has eviscerated or the presence of other clinical indications to operate. Evisceration should continue to prompt operative intervention.
Nagy
K
K
Department of Trauma, Cook County Hospital, Chicago, Illinois, USA. knagy@rush.edu
Roberts
R
R
Joseph
K
K
An
G
G
Barrett
J
J
D000007:Abdominal Injuries / Q000150:complications*; D000328:Adult; D003106:Colon; D005260:Female; D006555:Hernia, Ventral / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007421:Intestine, Small; D007813:Laparotomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D008297:Male; D009852:Omentum; D018579:Patient Selection; D010533:Peritoneal Lavage; D010808:Physical Examination; D011446:Prospective Studies; D014193:Trauma Centers; D019564:Unnecessary Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*; D014951:Wounds, Stab / Q000150:complications*