Abdominal Stab Wound Exploration Periprocedural Care

  • Author: Richard B Lawson, MB, BCh, FCA; Chief Editor: Erik D Schraga, MD   more...
 
Updated: Jan 30, 2012
 

Equipment

  • Adequate light source or operating lamp
  • Sterile gloves
  • Surgical masks
  • Surgical caps
  • Protective eyewear
  • Sterile gowns
  • Sterile drapes
  • Cleaning solution (10% povidone iodine [Betadine] or other suitable solution)
  • Lidocaine hydrochloride (1%) with epinephrine
  • Gauze swabs
  • Suture material (See Technique for suggestion of suture material.)
  • Wound dressing
  • Washout irrigant (1 L of 0.9% NaCl)
  • Scalpel handle
  • Blades, 2
  • Retractors, 2
  • Dissecting forceps (toothed and untoothed)
  • Needle holder
  • Scissors (curved dissecting and stitch scissors)
  • Hemostats, 5
  • Diathermy may be used, if available. Diathermy assists with achieving hemostasis.Equipment required for an abdominal stab wound expEquipment required for an abdominal stab wound exploration.
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Patient Preparation

Anesthesia

  • Local anesthesia is used.
  • Use local anesthesia liberally, as patient comfort is essential. The procedure requires patient compliance and adequate anesthesia. Hemostasis is also important.
  • The authors’ suggested preparation is 1% lidocaine hydrochloride (10 mg/mL) with epinephrine 1:200,000 (5 mcg/mL). Other preparations can be used.
  • The maximum dose of lidocaine combined with epinephrine is 7 mg/kg, up to 500 mg.
  • Local exploration in uncooperative patients is best performed in the operating room under general anesthesia.

For more information, see Local Anesthetic Agents, Infiltrative Administration.

Positioning

  • The patient is positioned supine.
  • Adequate exposure of the abdomen is essential.
  • Abdominal stab wound exploration can be effectively performed in the emergency department
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Contributor Information and Disclosures
Author

Richard B Lawson, MB, BCh, FCA  Consultant Anesthesiologist, Department of Anesthesia, Charlotte Maxeke Johannesburg Academic Hospital and University of the Witwatersrand

Richard B Lawson, MB, BCh, FCA is a member of the following medical societies: South African Medical Association and South African Society of Anaesthesiologists

Disclosure: Nothing to disclose.

Coauthor(s)

Jacques Goosen, MB, ChB, (PRET), FCSSA  Principal Surgeon and Head, Trauma Unit, Johannesburg Hospital and University of the Witwatersrand

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Luis M Lovato, MD  Associate Clinical Professor, University of California, Los Angeles, David Geffen School of Medicine; Director of Critical Care, Department of Emergency Medicine, Olive View-UCLA Medical Center

Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Gil Z Shlamovitz, MD  Assistant Professor, Section of Emergency Medicine, Baylor College of Medicine; Director of Medical Informatics, Emergency Center, Ben Taub General Hospital

Gil Z Shlamovitz, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Additional Contributors

Acknowledgments

Hannah Swart, Switch Design, South Africa, for the illustrations.

Johannesburg Hospital Trauma Unit, for assistance in obtaining material for the article.

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Transverse section of the anterior abdominal wall above the arcuate line.
Transverse section of the anterior abdominal wall below the arcuate line.
Boundaries of the anterior abdominal wall.
Stab wound to the anterior abdomen.
Equipment required for an abdominal stab wound exploration.
Sterile field.
Anesthetize the wound.
Midline wound: Extend vertically.
Lateral wound: Extend horizontally.
Visualize depths of the wound and maintain hemostasis.
Explore under direct vision.
Nonpenetrating wound: External oblique muscle intact in base of wound.
Penetrating midline wound.
Penetrating lateral wound. (The exploration of this wound clearly determined that the stomach had been penetrated. Therefore, the patient did not require diagnostic peritoneal lavage [DPL], as laparotomy was already indicated. During laparotomy, a hole in the stomach and 2 holes in the small bowel were repaired. The patient had an uneventful postoperative course and was discharged from the hospital 3 days later.)
Suture wound in layers. (This patient sustained a nonpenetrating stab wound to the abdomen. After the wound was repaired, the patient was discharged from the emergency department, and routine follow-up wound care was arranged with the local clinic.)
Selecting candidates for laparotomy
 
 
 
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