eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Abdominal Trauma, Penetrating: Multimedia

Author: Paul A Testa, MD, Resident, Department of Emergency Medicine, New York University Medical Center, Bellevue Hospital
Coauthor(s): Eric Legome, MD, Chair, Department of Emergency Medicine, St Vincent's Hospital, Manhattan; Lewis J Kaplan, MD, FACS, FCCM, FCCP, Director, SICU and Surgical Critical Care Fellowship, Associate Professor, Department of Surgery, Section of Trauma, Surgical Critical Care, and Surgical Emergencies, Yale University School of Medicine
Contributor Information and Disclosures

Updated: Jul 28, 2008

Multimedia

Note that the resident is carefully maintaining t...
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Media file 1: Note that the resident is carefully maintaining the position of the impaled stop sign post, so as not to dislodge the shaft. The shaft was removed in the OR along with the patient's right colon.
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Note that the resident is carefully maintaining t...

Note that the resident is carefully maintaining the position of the impaled stop sign post, so as not to dislodge the shaft. The shaft was removed in the OR along with the patient's right colon.

This is an operative photograph of an extremely r...
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Media file 2: This is an operative photograph of an extremely rare injury: a midureteral transection from a gunshot wound. The patient was shot with a MAC-10 machine gun and sustained the liver injury pictured in Image 3 as well as injuries to the duodenum, colon, terminal ileum, sigmoid colon, rectum, gallbladder, bladder, and left femur. He underwent a damage control operation and survived his injuries after 3 subsequent operations.
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This is an operative photograph of an extremely r...

This is an operative photograph of an extremely rare injury: a midureteral transection from a gunshot wound. The patient was shot with a MAC-10 machine gun and sustained the liver injury pictured in Image 3 as well as injuries to the duodenum, colon, terminal ileum, sigmoid colon, rectum, gallbladder, bladder, and left femur. He underwent a damage control operation and survived his injuries after 3 subsequent operations.

This is the liver injury sustained by the patient...
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Media file 3: This is the liver injury sustained by the patient in Image 2. The injury has been opened to control bleeding branches of the portal and hepatic veins as well as the hepatic arterial radicles. Several biliary ducts were ligated, and the back wall of the gallbladder can be identified in the depths of the wound. A cholecystectomy was required for management of the wound.
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This is the liver injury sustained by the patient...

This is the liver injury sustained by the patient in Image 2. The injury has been opened to control bleeding branches of the portal and hepatic veins as well as the hepatic arterial radicles. Several biliary ducts were ligated, and the back wall of the gallbladder can be identified in the depths of the wound. A cholecystectomy was required for management of the wound.

The patient's small intestine clearly protrudes t...
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Media file 4: The patient's small intestine clearly protrudes through his anterior abdominal wall following a stab wound caused by a machete. The operative repair and recovery were uneventful.
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The patient's small intestine clearly protrudes t...

The patient's small intestine clearly protrudes through his anterior abdominal wall following a stab wound caused by a machete. The operative repair and recovery were uneventful.

A standard diagnostic peritoneal lavage (DPL) cat...
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Media file 5: A standard diagnostic peritoneal lavage (DPL) catheter is secured in place following an open DPL. An aspirating syringe is attached to the catheter via extension tubing as the initial step in the evaluation for intraperitoneal blood.
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A standard diagnostic peritoneal lavage (DPL) cat...

A standard diagnostic peritoneal lavage (DPL) catheter is secured in place following an open DPL. An aspirating syringe is attached to the catheter via extension tubing as the initial step in the evaluation for intraperitoneal blood.

An ED thoracotomy has been performed, and the aor...
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Media file 6: An ED thoracotomy has been performed, and the aorta is cross-clamped. Note the proper positioning of the ratchet mechanism of the rib spreader to allow extension of the incision to the right chest for a clamshell thoracotomy if needed. This patient arrived with a weak pulse and a systolic blood pressure of 40 mm Hg and promptly died on the ED stretcher. An ED thoracotomy was performed for cardiopulmonary-cerebral resuscitation.
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An ED thoracotomy has been performed, and the aor...

An ED thoracotomy has been performed, and the aorta is cross-clamped. Note the proper positioning of the ratchet mechanism of the rib spreader to allow extension of the incision to the right chest for a clamshell thoracotomy if needed. This patient arrived with a weak pulse and a systolic blood pressure of 40 mm Hg and promptly died on the ED stretcher. An ED thoracotomy was performed for cardiopulmonary-cerebral resuscitation.

The patient's head is to the right, and the feet ...
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Media file 7: The patient's head is to the right, and the feet are to the left. An oblique incision has been made in the groin to expose the greater saphenous vein, which has been cannulated with a 14G catheter over a needle assembly. Same patient as in Image 6.
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The patient's head is to the right, and the feet ...

The patient's head is to the right, and the feet are to the left. An oblique incision has been made in the groin to expose the greater saphenous vein, which has been cannulated with a 14G catheter over a needle assembly. Same patient as in Image 6.

This patient has a temporary abdominal wall closu...
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Media file 8: This patient has a temporary abdominal wall closure composed of a bowel bag and polypropylene mesh, which has been sewn to his skin to treat abdominal compartment syndrome following a gunshot would to the abdomen. He was reexplored numerous times through the temporary closure prior to definitive repair.
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This patient has a temporary abdominal wall closu...

This patient has a temporary abdominal wall closure composed of a bowel bag and polypropylene mesh, which has been sewn to his skin to treat abdominal compartment syndrome following a gunshot would to the abdomen. He was reexplored numerous times through the temporary closure prior to definitive repair.

This 22-year-old woman sustained a gunshot wound ...
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Media file 9: This 22-year-old woman sustained a gunshot wound to the left flank. At exploration, she had a through-and-through laceration of her spleen. The bleeding was arrested by finger compression of the splenic hilum while it was mobilized. A splenectomy was performed because the bullet went through the hilum.
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This 22-year-old woman sustained a gunshot wound ...

This 22-year-old woman sustained a gunshot wound to the left flank. At exploration, she had a through-and-through laceration of her spleen. The bleeding was arrested by finger compression of the splenic hilum while it was mobilized. A splenectomy was performed because the bullet went through the hilum.

A 34-year-old man flipped over the handlebars of ...
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Media file 10: A 34-year-old man flipped over the handlebars of his motorcycle and landed on a wrought-iron fence. His helmet was knocked off when he landed. The medics cut the fence apart and transported the patient and fence to the ED (see image). On presentation, the patient's vital signs are as follows: rectal temperature, 95.3°F; heart rate, 126 beats per minute; respiration rate, 24 (labored); and blood pressure, 94/62 in his left arm. Intubation, bilateral upper extremity intravenous access, 2000 mL intravenous fluid, AP CXR, and operation is the correct sequence in which to resuscitate the patient to address the ABCs.
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A 34-year-old man flipped over the handlebars of ...

A 34-year-old man flipped over the handlebars of his motorcycle and landed on a wrought-iron fence. His helmet was knocked off when he landed. The medics cut the fence apart and transported the patient and fence to the ED (see image). On presentation, the patient's vital signs are as follows: rectal temperature, 95.3°F; heart rate, 126 beats per minute; respiration rate, 24 (labored); and blood pressure, 94/62 in his left arm. Intubation, bilateral upper extremity intravenous access, 2000 mL intravenous fluid, AP CXR, and operation is the correct sequence in which to resuscitate the patient to address the ABCs.

More on Abdominal Trauma, Penetrating

Overview: Abdominal Trauma, Penetrating
Differential Diagnoses & Workup: Abdominal Trauma, Penetrating
Treatment & Medication: Abdominal Trauma, Penetrating
Follow-up: Abdominal Trauma, Penetrating
Multimedia: Abdominal Trauma, Penetrating
References
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References

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Further Reading

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Keywords

gunshot wound, GSW, stab wounds, SW, shotgun wounds, impalement, penetrating trauma, penetrating abdominal wounds, penetrating abdominal trauma, intra-abdominal hemorrhage, peritonitis, intra-abdominal injury, peritoneal injury, abdominal injury, abdominal trauma, intraperitoneal injury

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Contributor Information and Disclosures

Author

Paul A Testa, MD, Resident, Department of Emergency Medicine, New York University Medical Center, Bellevue Hospital
Paul A Testa, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Emergency Medicine Residents Association
Disclosure: Nothing to disclose.

Coauthor(s)

Eric Legome, MD, Chair, Department of Emergency Medicine, St Vincent's Hospital, Manhattan
Eric Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Lewis J Kaplan, MD, FACS, FCCM, FCCP, Director, SICU and Surgical Critical Care Fellowship, Associate Professor, Department of Surgery, Section of Trauma, Surgical Critical Care, and Surgical Emergencies, Yale University School of Medicine
Lewis J Kaplan, MD, FACS, FCCM, FCCP is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Association for Academic Surgery, Association for Surgical Education, Connecticut State Medical Society, Eastern Association for the Surgery of Trauma, International Trauma Anesthesia and Critical Care Society, Society for the Advancement of Blood Management, Society of Critical Care Medicine, and Surgical Infection Society
Disclosure: Nothing to disclose.

Medical Editor

Roy Alson, MD, PhD, FACEP, FAAEM, Associate Professor, Department of Emergency Medicine, Wake Forest University School of Medicine; Medical Director, Forsyth County EMS; Deputy Medical Advisor, North Carolina Office of EMS; Associate Medical Director, North Carolina Baptist AirCare
Roy Alson, MD, PhD, FACEP, FAAEM is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, North Carolina Medical Society, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jon Mark Hirshon, MD, MPH, Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine
Jon Mark Hirshon, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Public Health Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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