Penetrating Injury

by Kevin Pei, MD

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    00:01 Now, we’ve discussed blunt injury, let’s talk about penetrating injury.

    00:06 Penetrating injury in the United States has decreased significantly.

    00:09 In fact, most trauma centers see 85% blunt injury patients.

    00:12 This is good for our patients.

    00:15 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.

    00:24 In fact, most penetrating abdominal surgeries require at least a diagnostic laparoscopy.

    00:30 That’s in the hope of avoiding a major exploratory laparotomy incision particularly if the exploratory laparotomy may turn out to be negative.

    00:41 Now, remember, if there is a question of peritoneal violation, which is the indication for surgery, you can always offer a diagnostic laparoscopy.

    00:49 Small little incisions take a look at it while the patient is asleep.

    00:52 Or alternatively, you can do what’s called a local wound exploration.

    00:56 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.

    01:03 If you notice that there is peritoneal violation or suspect it, the patient needs to have an exploration.

    01:09 Now, let me pose another clinical scenario.

    01:11 What if patient is stabbed from the left flank with a butcher’s knife? What are some potential injuries? I’ll give you a second to think about it.

    01:23 Let’s go over the potential injuries.

    01:25 I hope you kept these in mind.

    01:27 Clearly, anything on the left flank can injure the kidney, colon, small intestines, aorta, and the ureter.

    01:36 Now, in this image, you see a colon injury.

    01:41 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.

    01:55 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.

    02:05 In all penetrating colon surgeries prior to making incision, the patient should get pre-operative antibiotics.

    02:12 Remember, you can close the hole primarily if there is very minimal spillage.

    02:15 No drains are usually necessary.

    02:18 However, this is not the case if there’s a lot of contamination.

    02:22 In these situations with significant contamination either a blood or a stool, patient may need a temporizing ostomy.

    02:31 Here you see an ostomy.

    02:32 Remember, tell the patient it’s temporary.

    02:34 And with significant stool spillage, I recommend you leave some drains.

    About the Lecture

    The lecture Penetrating Injury by Kevin Pei, MD is from the course Surgery: Trauma.

    Included Quiz Questions

    1. Liver
    2. Colon
    3. Ureter
    4. Kidney
    5. Small intestine
    1. Ostomy
    2. Otomy
    3. Co-amoxiclav
    4. Topical antiseptics
    5. Metronidazole

    Author of lecture Penetrating Injury

     Kevin Pei, MD

    Kevin Pei, MD

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