title: Self-inflicted abdominal stab wounds.
abstract: BACKGROUND
  Self-inflicted abdominal stab wounds (ASWs) are uncommon. The present study aims to characterize the clinical profile of this unique group of psychiatric-surgical patients.
  
  
  METHODS
  A retrospective review of 23 patients with intentional self-inflicted ASWs at two urban level I trauma centres during a 10-year period.
  
  
  RESULTS
  Most patients were males (70%), ages ranging from 21 to 82 years (mean 40 years). Seventy-four percent of patients had a previous psychiatric history and prior suicide attempts were common (41%). Half of the patients had a positive admission drug or alcohol screen. Hypotension (systolic blood pressure (SBP) < 90 mmHg) was present in only two patients. Mean injury severity, revised trauma and Glasgow coma scores were 5.8, 7.7 and 14.5, respectively. The most commonly used instrument was a knife (87%). There were 1.5 external wounds per patient located primarily in the right upper quadrant (40%) and right lower quadrant (23%). These were associated with extra-abdominal wounds in 22% of cases. Local wound exploration was positive in 15 patients (65%), who all underwent laparotomy. Injured intra-abdominal or retroperitoneal organs were identified in 10 patients and included the stomach, duodenum, small bowel, colon, mesentery, inferior vena cava (IVC) and psoas muscle with a mean of 1.7 injuries per patient. Wound infection was the only post-operative complication (two patients). All eight patients with a negative local wound exploration were observed without complication. Seventy percent of patients were ultimately transferred to a psychiatric ward with a mean length of stay on the surgical service of 8 days. Only one patient died during admission due to metastatic malignant disease.
  
  
  CONCLUSIONS
  Self-inflicted ASWs in suicidal patients can induce significant although most likely non-lethal abdominal and retroperitoneal injuries. This observation should guide the trauma surgeon when treating such patients.
authors.affiliation: Section of Trauma and Surgical Critical Care, Department of Surgery, Yale University School of Medicine, 333 Cedar Street, LH 118, New Haven, CT 06520-8062, USA.
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
authors.forename: Amy
authors.initials: A
authors.lastname: Nuernberg
authors.forename: Reuven
authors.initials: R
authors.lastname: Rabinovici
mesh_terms: D000007:Abdominal Injuries / Q000453:epidemiology / Q000523:psychology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016728:Self-Injurious Behavior / Q000453:epidemiology / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology; D014504:Urban Health; D014951:Wounds, Stab / Q000523:psychology*