What is Penetrating Abdominal Trauma (Stab Wounds in the Belly)?
Penetrating injuries to the abdomen are quite common in many places around the world and are most often caused by stabbings or gunshots. The organs most frequently damaged include the small intestine (50%), large intestine (40%), liver (30%), and blood vessels inside the abdomen (25%). When gunshot or stab wounds occur at a close range, they tend to cause more damage due to higher energy.
Interestingly, gunshot wounds often follow a straight path, but those that are high-energy can cause injuries that are difficult to predict. There could also be additional injuries from fragments of bone or parts of the bullet that might scatter in different directions. Abdominal stab wounds are especially hard to assess, leading to the potential for hidden injuries being overlooked initially. These missed injuries can lead to complications down the line, increasing the overall health risk for the patient.
What Causes Penetrating Abdominal Trauma (Stab Wounds in the Belly)?
Penetrating trauma happens when something foreign pierces the skin and enters the body, creating a wound. In contrast, blunt or non-penetrating trauma doesn’t necessarily break the skin.
With penetrating trauma, the object either stays in the body or passes through it and exits, leaving a wound. If an object enters and exits the body, it’s called a perforating injury. These injuries come with two wounds, one where the object entered the body and another where it exited.
Penetrating trauma usually refers to situations where the object doesn’t pass through the body. This could be caused by violent incidents and might be the result of broken bone fragments, gunshots, or knife wounds.
These kinds of injuries often damage internal organs, which can result in shock and infections. How severe the injury is can depend on what organs are involved, the characteristics of the object, and how much energy was transmitted. Doctors often use X-rays, CT scans, or MRI to assess the injury. Treatment usually involves surgery to fix damaged structures and remove any foreign objects.
Puncture trauma is similar to penetrating trauma but with one key difference. A puncture doesn’t have an exit wound and is usually caused by something sharp or pointed. This kind of injury can happen when someone gets stabbed or steps on a nail.
Risk Factors and Frequency for Penetrating Abdominal Trauma (Stab Wounds in the Belly)
In the United States, both suicide and homicide are significant causes of death, and injuries to the torso from firearms constitute a considerable percentage of these. Traumatic injury in general is a major cause of death, particularly for people aged 1 to 44 years old. Interestingly, a large portion of patients admitted to trauma centers in urban areas are victims of penetrating abdominal trauma. However, this rate is lower in suburban or rural centers.
Globally, the occurrence of penetrating abdominal injuries tends to rise with the availability of weapons and during times of military conflict. Consequently, the frequency can vary greatly depending on the specific circumstances.
When viewed from a racial perspective, non-Hispanic black males exhibit firearm death rates that are two to seven times higher than their counterparts (when adjusted for age). As for gender, the vast majority of patients with penetrating trauma are male.
- 40% of homicides and 16% of suicides involve firearm injuries to the torso in the U.S.
- In the U.S., traumatic injury is the third leading cause of death and is the top cause amongst people aged 1 to 44 years old.
- Penetrating abdominal trauma affects 35% of those admitted to urban trauma centers, and 12% of those admitted to suburban or rural facilities.
- The rate of penetrating abdominal injuries internationally can increase based on the accessibility of weapons and the presence of military conflicts.
- Adjusted for age, non-Hispanic black males show firearm death rates that are two to seven times higher than in other demographics.
- About 90% of patients who experience penetrating trauma are male.
Signs and Symptoms of Penetrating Abdominal Trauma (Stab Wounds in the Belly)
Penetrating abdominal trauma occurs from incidents like stabbings, gunshot wounds, or industrial accidents and can be life-threatening due to the heavy bleeding that can occur from injured abdominal organs. For example, an injury to the pancreas could result in further damage due to autodigestion, while damage to the liver could cause shock due to its rich blood supply. The intestines could also be at risk for perforation and infection, especially if fecal matter is involved in the penetration.
This type of bodily harm can lead to conditions like hypovolemic shock and peritonitis. Symptoms of these conditions could include reduced bowel sounds due to bleeding, infection, or irritation and abnormal artery sounds known as bruits due to injuries. A physical examination might reveal either an unusually resonant or a dull sound when the abdomen is tapped gently, which could suggest the presence of blood. Other symptoms may include a swollen or tender abdomen, which can indicate a need for surgery.
The standard course of action for managing penetrating abdominal trauma is usually a surgical procedure called laparotomy. However, an increased understanding of how the injury occurs and better imaging techniques have allowed for less invasive treatments in some situations.
Testing for Penetrating Abdominal Trauma (Stab Wounds in the Belly)
Assessing the damage can be tough, as it’s often hidden deep inside the body. The first step that medical professionals take is a physical examination of the patient. After that, they might use an ultrasound, an x-ray, or a CT scan to get a better idea of what’s going on inside. Sometimes, a paper clip is taped over the entry and exit wounds of the patient before taking an x-ray.
In terms of treatment, the patient will receive fluids or blood through an IV. Oftentimes, surgery is necessary. If there are objects lodged inside the patient, they are kept stable so they don’t move around. It’s important that these should only be removed in a surgical setting.
Bullets or similar foreign bodies can sometimes be taken out, but if there’s a chance that they could cause more harm by doing so, they are typically left where they are. The wounds are thoroughly cleaned to remove any tissue that has been too damaged to survive and could potentially cause an infection.
Treatment Options for Penetrating Abdominal Trauma (Stab Wounds in the Belly)
If a patient comes in with a stomach injury from an object puncturing their abdomen, the symptoms often include shock, low blood pressure, quick shallow breathing, decreased urine output, and visible signs of an open wound or injury track. If the patient is conscious, they might show signs of peritonitis, an inflammation of the abdomen’s lining, including uncontrolled tenseness or severe sensitivity in the affected area.
The way doctors approach these penetrating abdominal traumas hinges on what caused the injury and the patient’s physical state. Generally, gunshot wounds to the abdomen often damage the hollow organs like the stomach, small intestine, and large intestine, requiring surgical exploration. Stab wounds, often causing less severe internal injuries, need a careful evaluation that calls for experienced medical judgement.
Though blood tests will be done, they don’t provide specific details. Procedures like DPL (Diagnostic Peritoneal Lavage) and FAST (Focused Assessment with Sonography for Trauma) can evaluate a patient with either a gunshot or stab wound, but these procedures often have a high rate of false negatives. CT scans, especially triple contrast CT scans, are the preferred diagnostic tests for those considered stable. These scans can also evaluate injuries to solid organs. Additional imaging may be necessary to check for head or skeletal injuries.
Typically, a trauma team handles these types of penetrating injuries in hospitals. After initial evaluation and treatment of immediate life-threatening conditions (the ABCs), most gunshot victims require surgery to explore the abdomen. This traditional approach has evolved and today, stable gunshot victims without peritonitis signs, and who’ve had a triple contrast CT scan revealing no internal injuries, might be observed without surgery.
The decision to proceed with surgery depends on certain indicators. These include unstable blood pressure, development of peritonitis symptoms (like uncontrolled tenseness or severe sensitivity) and persistent stomach pain that is unresponsive to treatment. Surgery typically involves management of bleeding, quick detection of serious injuries, rapid containment of contamination, and reconstruction where possible. If there’s injury to blood vessels, they’ll recommend a vascular surgeon.
Patients with clear signs of peritonitis due to a stab wound also typically require surgery. Stable patients may undergo a local examination or a triple contrast CT scan.
Regarding the patient’s outcome, it can vary widely and depends on the injury severity and how quickly they’re brought to the emergency department. Patients with a large amount of contamination in the abdomen from a ruptured organ, bleeding, multiple injured organs, associated head injury or coagulation disorders, face a higher risk of death. However, for patients who are promptly resuscitated and examined, the death rates remain low. Stab wounds generally have a better outcome than gunshot wounds.
Based on the injury’s severity, patients often require a rehabilitation period to regain their prior function level.
What else can Penetrating Abdominal Trauma (Stab Wounds in the Belly) be?
There are several conditions that can resemble the symptoms of abdominal compartment syndrome (excessive pressure in the abdomen), including:
- Shock caused by severe blood loss, or hemorrhagic shock
- Injuries to the pelvic region, diaphragm (muscle used for breathing), or the urinary and reproductive organs
- A severe body-wide infection, known as sepsis
It’s crucial for healthcare professionals to be aware of these possibilities and use precise tests to confirm the correct diagnosis.
Possible Complications When Diagnosed with Penetrating Abdominal Trauma (Stab Wounds in the Belly)
- Bloodstream infections
- Abnormal connections between organs (Fistulas)
- Separation of a surgical wound’s edges (Wound dehiscence)
- Creation of an opening in the abdomen for waste removal (Colostomy/Ileostomy)
- Condition where the body cannot absorb enough nutrients from food due to removal or disease of a large part of the small intestine (Short bowel syndrome)
Preventing Penetrating Abdominal Trauma (Stab Wounds in the Belly)
It’s crucial to understand the risks associated with firearms. Even though they can provide safety, if not handled correctly, they can also cause serious harm. Being well-educated about how to use and respect firearms is essential to avoid accidents.
