Penetrating abdominal trauma

Penetrating injury to the abdomen is most commonly a result of stabbing or gunshot. The mortality of penetrating injury is slightly lower than that of blunt injury. The most commonly affected organs are the liver and small intestine.

Diagnosis, evaluation, and management

As with all trauma patients, the initial trauma primary survey (ABCDE) and stabilisation is essential.

In the physical examination of a penetrating injury victim, it’s important to completely undress the patient and examine the whole body to look for hitherto unknown wounds.

Contrary to what may be instinctual, a penetrating object which remains implanted in the patient should not be removed until in a setting where definitive care is possible, like the operating room. Penetrating objects often tamponade the wound and so removing them may worsen the clinical condition.

Due to the high risk of small bowel injury, broad spectrum antibiotics should be administered prophylactically. Tetanus prophylaxis may also be necessary.

Emergency laparotomy is indicated in:

• Evisceration
• Impalement (foreign object remaining)
• Signs of peritonitis
• Haemodynamic instability

If none of the above indications are present, eFAST and/or abdominal CT should be performed, which may show evidence of an injury which is an indication for emergency laparotomy. Patients who remain haemodynamically stable and with a negative eFAST and CT should be admitted for observation.