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- W3159915639 abstract "An 87-year-old woman who had hypertensive cardiovascular disease was brought to the emergency department after stabbing herself in the abdomen with a fruit knife. The knife was held in place with a mask and triangular bandages during transportation. Her vital signs were blood pressure 149/71 mm Hg, pulse rate 91 beats/min, respiratory rate 16 breaths/min, and temperature 36.6°C (97.9°F) on arrival. Physical examination revealed a retained knife over the periumbilical region and local tenderness without muscle guarding (Figure 1). Bedside point-of-care ultrasonography of the abdomen showed a linear object penetrating the parietal peritoneum, with a surrounding hematoma (Figure 2 and Video E1). The patient underwent emergency exploratory laparotomy with omental repair and removal of the knife (Figures 3 and 4). She was discharged uneventfully 9 days later.Figure 2Bedside point-of-care ultrasonography showing a linear hyperechoic structure (arrowhead) and hypoechoic collection (star), indicating a foreign body with surrounding hematoma.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Exploratory laparotomy revealing an omental perforation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 4A 9.5-cm knife after removal.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Penetrating abdominal injury with retained weapon and omental perforation. The organs that stab wounds involve most commonly are the liver (40%), followed by small bowel (30%), diaphragm (20%), and colon (15%). In addition to hemodynamic instability and peritonitis, indications for immediate exploratory laparotomy include evisceration and impalement.1Martin M.J. Brown C.V.R. Shatz D.V. et al.Evaluation and management of abdominal stab wounds: a Western Trauma Association critical decisions algorithm.J Trauma Acute Care Surg. 2018; 85: 1007-1015Crossref PubMed Scopus (13) Google Scholar Ultrasonography can be valuable in detecting parietal fascia defects in patients with anterior abdominal penetrating trauma, with a report of 59% sensitivity and 100% specificity.2Murphy J.T. Hall J. Provost D. Fascial ultrasound for evaluation of anterior abdominal stab wound injury.J Trauma. 2005; 59: 843-846Crossref PubMed Scopus (18) Google Scholar Surgical removal of a retained weapon under direct vision is always required because the severity of vascular damage may not be correlated with hemodynamic stability owing to the occasional “plugging” effect by the weapon.3Quraishi A.H. Inferior vena caval injury following self-inflicted abdominal stab wound.Indian J Surg. 2008; 70: 35-36Crossref PubMed Scopus (1) Google Scholar Under cautious examination, ultrasonography can provide evidence of parietal fascia defects in abdominal stab wounds before surgical exploration. https://www.annemergmed.com/cms/asset/01cec6b5-cbab-45fe-ba51-f1468446da08/mmc1.mp4Loading ... Download .mp4 (2.43 MB) Help with .mp4 files Video E1Bedside point-of-care ultrasonography showing a knife penetrating the peritoneum, with surrounding hematoma." @default.
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- W3159915639 date "2021-05-01" @default.
- W3159915639 modified "2023-09-23" @default.
- W3159915639 title "Elderly Patient With Abdominal Stab Wound" @default.
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- W3159915639 doi "https://doi.org/10.1016/j.annemergmed.2020.11.002" @default.
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