Evisceration after abdominal stab wounds: Is laparotomy required?

Objectives: To determine the incidence of intra-abdominal injury requiring laparotomy after an abdominal stab wound with evisceration, To identify cli nical signs that increase the likelihood of an intra-abdominal injury in th e presence of such a wound. Methods: Information was collected prospectively over an 8-year period on a ll patients who presented to our urban Level I trauma center with an abdomi nal stab wound and evisceration. This information included which organ evis cerated, presence of other indications for laparotomy, organs injured, and postoperative complications. All comparisons used the Fisher's exact chi(2) . Results: A total of 81 patients were admitted with evisceration after an ab dominal stab wound. Sixty-one patients (75%) had eviscerated omentum, 18 pa tients (22%) had eviscerated small bowel, and 2 patients (2%) had eviscerat ed colon, Sixty-two patients (76%) had evisceration as the sole indication for laparotomy, the remaining 19 patients (24%) had another indication such as hypotension or peritonitis. Overall, 63 patients (78%) had an intra-abd ominal injury that required repair. This was true regardless of organ evisc erated (omentum = 77% vs. viscus = 80%, not significant) or clinical presen tation (no other indication = 76% vs. another indication = 84%, not signifi cant). Conclusion: The majority of patients who present with an evisceration after a stab wound to the abdomen require a laparotomy. This is true regardless of what has eviscerated or the presence of other clinical indications to op erate. Evisceration should continue to prompt operative intervention.