Presentation
Stabbing to abdomen. Heamodynamically stable.
Patient Data
Metallic artefact from the two metallic knives:
The more superior enters from the midline and is directed towards the right superior anterior abdominal wall.
The inferiorly directed knife breaches peritoneum, tip abuts and indents the IVC at L3/L4 level.
No retroperitoenal haemorrhage. Due to artefact, it is difficult to exclude an adjacent small bowel injury. No definite small bowel wall thickening. The large bowel is clear and normal in appearance. No mesenteric stranding. Major intra-abdominal vessels opacify normally. The solid organs are normal in appearance. No free air within the abdomen. No free intraperitoneal fluid. Extensive subcutaneous stranding and scarring of the soft tissues of the anterior abdominal wall.
The lung bases are clear. No acute or concerning osseous lesion.
Impression
Two knives in the abdomen. The first knife is in anterior abdominal wall. The second knife is breaching the peritoneal cavity, passing adjacent to mesentery and small bowel. The tip indents the IVC at the L3/L4 level. No definite evidence of vascular or bowel injury. No free air.
Case Discussion
The patient had a history of deliberate self-harm and had several prior episodes of self stabbing.
Operative report:
Very thick dense scar throughout abdominal wall
Dense omental adhesions to midline abdominal wall but minimal SB & LB adhesions
Small amount of bloody free fluid & clot
Knife removed under vision without bleeding or retroperitoneal haematoma
No contamination
No bowel injury identified from DJ flexure to colon
No IVC injury
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