Abdominal Stab Injuries

Emergency clinicians manage stab wound (SW) injuries now more than ever. This topic review will discuss the evaluation and management of abdominal stab wounds.

Primary Survey:

History:
AMPLE
A-allergies, M- medication, P- past medical experience, L- last oral intake, E- events surrounding the injury (Penetrating trauma).
Physical examination:
Airway.
Breathing.
Circulation, control of haemorrhage by proximal compression of vessel, by packing of wound, by ligation of the bleeding vessel.
Assessment of DISTAL neurological status and level of consciousness:
A-awake. V- open eyes to voice P- open eyes to painful stimuli U- unarousable
Exposure:
  • Patient completely disrobed,
  • Visual inspection of the entire patient, Examine the back as well.
  • Record entry and exit of stab wound in full dimensions with relation to bony landmarks.
  • Splaying of legs to examine the perineum.
  • Per-rectal examination.
  • Inform the registrar/attending.
Resuscitation:
  • Set up two I/V lines with branula #16 G
  • Draw blood samples for blood grouping and cross-matching, Hb%, PT, APTT.
  • Send investigations for urinalysis, pregnancy test for women of childbearing age.
  • Start I/V Ringer’s or normal saline.
  • Pass Foleys catheter #16 in adults with complete aseptic technique.

Classification of Abdominal Stab Wounds

I. Not penetrating the peritoneal cavity.
II. Penetrating but not damaging the organs.
III. Penetrating with significant damage.

Management:

Group III: Presents with signs of peritonitis and circulatory shock.  They need immediate resuscitation & exploration of abdominal cavity.
Group II, I:  Penetrating but occult injuries, need secondary abdominal survey.
Local wound exploration to rule out any peritoneal breach in stable patients.
  1. No breach – manage as deep laceration.
  2. Breach – penetration assumed and significant damage ruled out.
Options:
Admission, observation, USG, diagnostic peritoneal lavage, or laparoscopy laparotomy.