Equipment

The list of equipment is as follows:

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 exploration.
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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 Infiltrative Administration of Local Anesthetic Agents.

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.

Technique

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Media Gallery

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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Author

Juan L Poggio, MD, MS, FACS, FASCRS Professor of Surgery, Department of Surgery, Lewis Katz School of Medicine at Temple University; Colon and Rectal Surgeon, Department of Surgery, Cancer Treatment Centers of America; Colon and Rectal Surgeon and General Surgeon, Division of Colon and Rectal Surgery, Department of Surgery, Temple University Hospital and Jeanes Hospital

Juan L Poggio, MD, MS, FACS, FASCRS is a member of the following medical societies: American College of Surgeons, American Society of Colon and Rectal Surgeons, Association for Academic Surgery, Pennsylvania Society of Colon and Rectal Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Dane R Scantling, DO, MPH Fellow, Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania

Dane R Scantling, DO, MPH is a member of the following medical societies: American Association for the Surgery of Trauma, Eastern Association for the Surgery of Trauma, Pennsylvania Medical Society

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, Society for Academic Emergency Medicine

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

Richard B Lawson, MB, BCh, FCA, MMed(Anaes) Specialist Anesthesiologist, Dunkeld Anaesthetic Practice, Johannesburg, South Africa

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

Disclosure: Nothing to disclose.

Disclosure: Nothing to disclose.

Acknowledgements

Acknowledgments

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

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

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