Evisceration Following Abdominal Stab Wounds: Analysis of 66 Cases

Background  Abdominal stab wounds with evisceration remain an indication for emergency laparotomy. The purpose of this study was validate a policy of mandatory laparotomy for organ evisceration and a policy of selective nonoperative management with serial physical abdominal examination for omentum evisceration. Methods  The charts of 379 patients with abdominal stab wounds who presented to our Level I trauma center over a 3-year (January 2005 to December 2007) period were retrospectively reviewed. Altogether, 66 (17.4%) patients with evisceration were identified and included in the study. Indications for mandatory laparotomy were peritonitis, hemodynamic instability, organ evisceration, and a high spinal cord or severe head injury with an abdominal stab wound. Further data gathered included the organ eviscerated, intraabdominal organs injured, and complications. Injury severity was categorized using the revised trauma score (RTS), injury severity score (ISS), and penetrating abdominal index (PATI). Results  Organ and omentum evisceration occurred in 35 (53%) and 31 (47%) patients, respectively. Organs eviscerated were as follows (number of patients): small bowel in 27 (40.9%), stomach in 2 (3%), colon in 1 (1.5%), small bowel and stomach in 2 (3%), and small bowel and colon in 3 (4.5%). The mean RTS, ISS, and PATI scores were 7.71, 13.74, and 8.26, respectively. Only two (5.7%) patients with organ evisceration underwent a negative laparotomy. In total, 23 patients with omentum evisceration (21 with peritonitis, 1 with a head injury, 1 who failed abdominal observation) underwent therapeutic laparotomy. Six patients with omentum evisceration were managed successfully nonoperatively. Two patients with left thoracoabdominal omentum evisceration underwent delayed laparoscopy, which revealed a diaphragm injury in one patient. Overall, 57 (86.4%) patients with evisceration had an intraabdominal injury that required repair. Conclusions  Evisceration should continue to prompt operative intervention. An exception can be made to a select few patients with omentum evisceration with benign abdominal findings.