Selected Articles from the Journal

Abdominal Surgery

This article originally appeared in the Winter 2009 / Spring 2010 issue of the Journal.

Abdominal Stab Wounds

Dr. Faris Dawood Al-Aswad
MBCHB, FICMS, FISS, ASGS, ASAS, FICS
Spacialist General Surgeon
NMC Specialty Hospital (Dubai – UAE)

Digital exploration of the stab wound under local anesthesia must be performed to prove the
peritoneal penetration unless there were intra abdominal structures evisceration (omentum or
bowel), gas under the diaphragm detected by x-ray of the abdomen, positive abdominal
paracentesis, small wounds or immediate decision for laparotomy was established during the
initial evaluation of the condition. After the patient was evaluated on clinical grounds,we
placed the patient in one of these categories for analysis purposes:

Category A: (Immediate Laparotomy): Those patients group consist of patients thought to

have significant injury by criteria upon initial evaluation. This category includes 52 patients
(54.2%)

The indication for laparotomy:

1. Acute abdomen (peritoneal irritation) 25 patients had signs of acute abdomen:

Guarding or rigidity rebound tenderness or absent bowel sounds.
2. Intra-abdominal structures evisceration (omentum or bowel). 16 patients (12 patients
had omental evisceration and 4 patients had small bowel evisceration)
3. Shock or vasomotor instability: 5 patients
4. Gas under the diaphragm: 4 patients (3 of them had signs of acute abdomen and 1
patient had signs of vasomotor instability).
5. Uncontrolled bleeding from the wound: 1 patient.
6. GIT bleeding: no patient.
7. Frank haematuria: 1 patient

Category B: (Observation): This includes 44 patients(45.8%).These patients did not have

signs of peritoneal irritation or minimal signs of (mild localized tenderness around stab
wound) and vasomotor stability, they were admitted and managed under observation category
which this subdivided into two groups:

B1. (No Laparotomy): This group comprises 40 patients. Those patients were thought to
have no indication for surgery upon initial clinical examination and eventually they were
discharged from the hospital within 3-5 days without exploration.
B2. (Delayed laparotomy): Group includes 4 patients. Those patients were not thought to
have indications for Laparotomy upon initial clinical evaluation but then developed signs
which need surgical exploration during observation.

Category B (Observation category) comprise of 44 patients (45.8%). Six patients had small
stab wounds and digital exploration of the wounds was not done.

Thirty eight (38 patients) had peritoneal penetration was proved by digital exploration of the
wound under local anesthesia.