Penetrating Injuries to the Abdomen: a Single Institutional Experience with Review of Literature

Abstract

Penetrating abdominal trauma forms an important component of surgical emergencies, most of the victims being young aged in the prime of their life. Over the past century, the diagnosis and management of this common problem has seen drastic changes, finally reaching the destination of . We present our experience in the management of this group of patients in the rural setup. This is a prospective observational study done at our hospital between 1 April 2013 and 31 March 2015 including patients who presented with penetrating abdominal injury. The clinical presentation, imaging features, diagnosis, management, and complications of all these patients are analyzed. The mean age was 33.5 years with majority being males. Homicidal stab injuries accounted for most of the injuries (62.5 %). Forty-eight patients underwent laparotomy, and among which, the procedure was therapeutic in 36 patients. Peritoneal penetration was the best predictor of a therapeutic laparotomy with a high sensitivity and positive predictive value (100 and 80 %, respectively). The small intestine was the most commonly injured organ. The mean postoperative stay was 8.25 days, and there was no mortality. Though the management of these patients should aim at minimizing the rate of negative laparotomies, this should not be done at the expense of delayed diagnosis and treatment. Diagnostic laparoscopy may avoid unnecessary laparotomies; however, it requires adequate skills in laparoendoscopy. Management is best tailor made for each individual based on the nature of injury, findings at presentation, and the organ injured.

Multiple stab injuries in an infant with silent bowel perforations: a case report

“…Small bowel is the most common organ injured in penetrating abdominal trauma. 4 In a study by Arslan et al, the ileum was the most common organ involved in pediatric penetrating abdominal trauma. Almost 48 % of the cases with bowel perforation did not have air under the diaphragm on standing abdominal X-ray.…”

Damage control surgical management of combined small and large bowel injuries in penetrating trauma: Are ostomies still pertinent?

“…The preferred surgical methods are primary repair for minor injuries and limited bowel resection with primary anastomosis (preserving bowel length) for more extensive ones 31 . Small bowel ostomy is generally to be considered as a secondary option especially in light of complications that ensue from its high output 32 .…”

“…La técnica quirúrgica descrita para las lesiones leves es el reparo primario y para las severas la resección y anastomosis 31 . Generalmente, la ostomía no es una opción, dado a su asociación con complicaciones de fugas intestinales de alto gasto 32 .…”

The Evaluation, Management and Outcome about an Experience with Sharp Force Abdominal Injury

“…Penetrating abdominal injuries are a frequent emergency and may cause considerable troubles at emergency service [11]. Karamercan et al [12] concluded that approximately 10% of all trauma-related deaths occurred as a result of blunt or penetrating abdominal injuries.…”