Penetrating abdominal trauma with knife in-situ
Stab wound to the left flank at the L3 vertebral level. There was approximately 500 mL of blood loss. There was no deficit on neurological examination.
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There is a large metallic knife penetrating from the left flank craniocaudally and lateral to medial traversing the posterior abdominal wall quadratus lumborum, paraspinal muscles, deep fibers of the left psoas and below the left transverse process and lateral to the pedicle of the L2 lumbar vertebra. The tip appears situated within the vertebral body of L2 approximately 1 cm before the anterior margin of the vertebral body. The anatomical course of the injury raises the possibility of nerve root damage.
3 case question available
Penetrating trauma is one of the four mechanisms of traumatic injury. The other 3 types are:
- non-penetrating (blunt) trauma
- thermal injuries
- blast injuries
This patient suffered penetrating trauma to the posterior abdomen. The posterior aspect of the abdomen is better protected than the anterior abdomen due to the vertebral column and paraspinous muscles. Retroperitoneal injuries due to posterior abdomen penetrating trauma can still occur however, and include:
- small intestine perforations
- renal tract perforation
- vascular interruption
97% of patients with penetrating trauma to the posterior abdomen were caused by stab wounds in a recent study 1.
Penetrating trauma to the posterior abdomen is usually managed non-operatively unless clinical examination dictates otherwise 2. Clinical signs which may suggest operative management include tenderness not localized to the area of injury, as well as absent bowel sounds. In this particular case, laparotomy was indicated due to the knife still being in situ.
Case contributed by A/Prof. Pramit Phal.
- Butt MU, Zacharias N, Velmahos GC. Penetrating abdominal injuries: management controversies. Scand J Trauma Resusc Emerg Med.17 (1): 19. doi:10.1186/1757-7241-17-19 - Free text at pubmed - Pubmed citation
- Biffl WL, Moore EE. Management guidelines for penetrating abdominal trauma. Curr Opin Crit Care. 2010;16 (6): 609-17. doi:10.1097/MCC.0b013e32833f52d2 - Pubmed citation