Now, we’ve discussed blunt injury,
let’s talk about penetrating injury.
Penetrating injury in the United
States has decreased significantly.
In fact, most trauma centers
see 85% blunt injury patients.
This is good for our patients.
Now, penetrating abdominal injuries
are a little bit different than blunt
in the sense that they are more at risk
for perforation and may require surgery.
In fact, most penetrating
require at least a
That’s in the hope of avoiding a major
exploratory laparotomy incision
particularly if the exploratory
laparotomy may turn out to be negative.
Now, remember, if there is a
question of peritoneal violation,
which is the indication for surgery, you
can always offer a diagnostic laparoscopy.
Small little incisions take a look
at it while the patient is asleep.
Or alternatively, you can do what’s
called a local wound exploration.
I have to say particularly in
obese patients, it’s easier said
than done in the trauma bay but
it can be done under local.
If you notice that there
is peritoneal violation or
suspect it, the patient needs
to have an exploration.
Now, let me pose another
What if patient is stabbed from the
left flank with a butcher’s knife?
What are some
I’ll give you a second
to think about it.
Let’s go over the
I hope you kept these in mind.
Clearly, anything on the left
flank can injure the kidney,
aorta, and the ureter.
Now, in this image, you
see a colon injury.
What are your priorities?
Well, in the operating room
if done in a timely manner,
there should be very little
contamination or spillage of stool,
but our main goal is actually controlling
the contamination and maintain stability.
If all those cases are in a relatively
clean and controlled situation,
there’s nothing wrong with
just putting a suture and
closing the hole depending
on how big the hole is.
In all penetrating colon surgeries
prior to making incision,
the patient should get
Remember, you can close the hole primarily
if there is very minimal spillage.
No drains are usually necessary.
However, this is not the case if
there’s a lot of contamination.
In these situations with significant
contamination either a blood or a stool,
patient may need a
Here you see an ostomy.
Remember, tell the
patient it’s temporary.
And with significant stool spillage,
I recommend you leave some drains.