Management of patients with evisceration after abdominal stab wounds

In the era of nonoperative management of abdominal stab wounds, the optimal management of patients with evisceration remains unclear. Furthermore, the role of imaging in guiding management of these patients has not been defined. Patients admitted to a Level I trauma center (2005 to 2012) with evisceration after an abdominal stab wound were retrospectively identified. Demographics, admission vital signs, topography and contents of evisceration, Glasgow Coma Score, indications for exploration, and imaging and operative reports were abstracted. Clinical outcomes measured were: injuries identified on exploration, hospital length of stay, and mortality. Descriptive analysis was performed. Ninety-three patients with evisceration were identified. Ninety-two (98.9%) were male and 60 (64.5%) were Hispanic. Mean age was 31.9 ± 13 years. Forty-seven (50.5%) had evisceration of the omentum, 41 (44.1%) had evisceration of abdominal organs, and two (2.2%) had both. Seventy-four (80.4%) had positive laparotomies. Ten (10.8%) underwent computed tomography (CT) preoperatively. Sixty per cent of CT findings were congruent with operative findings. CT did not impact clinical management. In conclusion, the rate of intra-abdominal injury in patients with evisceration remains high. Even in the age of nonoperative management, evisceration continues to be an indication for immediate laparotomy. The diagnostic yield of CT is low and CT should not impact management of these patients.