Evisceration

A patient presents after a stab wound to the abdomen.  There is a piece of omentum eviscerating from the wound.  Is this an indication to go to the OR?

The answer is yes - over 75% of these patients have an intra-abdominal injury that requires repair.  This is true regardless of what has eviscerated - omentum or bowel. 
In addition to the high likelihood of an injury, there now exists an acute abdominal wall hernia that requires repair to prevent recurrent evisceration.

This is based on work done here at Cook County Trauma Unit (abstract below):

J Trauma. 1999 Oct;47(4):622-4; discussion 624-6.

Evisceration after abdominal stab wounds: is laparotomy required?

Nagy K, Roberts R, Joseph K, An G, Barrett J.

Source

Department of Trauma, Cook County Hospital, Chicago, Illinois, USA. knagy@rush.edu

Abstract

OBJECTIVES:

To determine the incidence of intra-abdominal injury requiring laparotomy after an abdominal stab wound with evisceration. To identify clinical signs that increase the likelihood of an intra-abdominal injury in the presence of such a wound.

METHODS:

Information was collected prospectively over an 8-year period on all patients who presented to our urban level I trauma center with an abdominal stab wound and evisceration. This information included which organ eviscerated, presence of other indications for laparotomy, organs injured, and postoperative complications. All comparisons used the Fisher's exact chi2.

RESULTS:

A total of 81 patients were admitted with evisceration after an abdominal stab wound. Sixty-one patients (75%) had eviscerated omentum, 18 patients (22%) had eviscerated small bowel, and 2 patients (2%) had eviscerated 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-abdominal injury that required repair. This was true regardless of organ eviscerated (omentum = 77% vs. viscus = 80%, not significant) or clinical presentation (no other indication = 76% vs. another indication = 84%, not significant).

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 operate. Evisceration should continue to prompt operative intervention.