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Clinical Summary

Evisceration of abdominal contents usually occurs after a stab or slash wound to the abdomen or after recent laparotomy. It is an indication for laparotomy. Other indications for laparotomy in penetrating abdominal trauma include unexplained shock and evidence of blood in the stomach, bladder, or rectum.

Management and Disposition

Initial resuscitation includes crystalloid and blood administration, oxygen, airway security, trauma laboratory studies, and cardiovascular monitoring. Mobilization of the trauma team is important management of penetrating abdominal trauma. Eviscerated bowel should be covered with saline-soaked gauze. Antibiotics with enteric coverage should be administered.

FIGURE 7.34

Abdominal Evisceration. Self-induced evisceration with bowel perforation and spillage of food particles is clearly seen in this photograph. This patient went directly to the operating room. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 7.35

Abdominal Evisceration. Evisceration of small bowel after assault and stab wound to the right lower abdomen. (Photo contributor: Frank Birinyi, MD.)

FIGURE 7.36

Bowel Evisceration through the Anus. High-energy blunt abdominal trauma to this elderly man resulted in evisceration of small bowel and omentum through his anus. (Photo contributor: Alan B. Storrow, MD.)

Pearls

  1. Evisceration, unexplained shock, or blood in the stomach, bladder, or rectum is an indication for laparotomy.

  2. Selected patients with stab wounds to the abdomen and peritoneal penetration may be conservatively observed for delayed complications. Some centers are using a nonoperative approach for patients with gunshot wounds to the abdomen as well.

  3. As many as 25% of patients with stab wounds to the abdomen can be discharged from the ED based on a negative wound exploration.

  4. Evisceration should not distract the provider from systematic resuscitation priorities.

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