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Mandatory Laparotomy in Penetrating Abdominal Injuries with Omental Evisceration: Experience in a Major Trauma Center in the Philippines

Background: Omental evisceration due to abdominal stab injuries connotes peritoneal penetration and translates to around 70% risk of intra-abdominal injury. Such cases are being managed with mandatory laparotomy at the Philippine General Hospital. This study aims to review the patient profile and la...

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Autores principales: De Robles, Marie Shella B, Ayuste Jr, Eduardo C
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823020/
https://www.ncbi.nlm.nih.gov/pubmed/31720157
http://dx.doi.org/10.7759/cureus.5688
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author De Robles, Marie Shella B
Ayuste Jr, Eduardo C
author_facet De Robles, Marie Shella B
Ayuste Jr, Eduardo C
author_sort De Robles, Marie Shella B
collection PubMed
description Background: Omental evisceration due to abdominal stab injuries connotes peritoneal penetration and translates to around 70% risk of intra-abdominal injury. Such cases are being managed with mandatory laparotomy at the Philippine General Hospital. This study aims to review the patient profile and laparotomy outcomes in such cases. Methods: This is a retrospective review of 98 consecutive laparotomies performed for patients with omental evisceration secondary to abdominal stab wounds between January 2004 to April 2018. Results: Almost all patients were male (99%) with a mean age of 32.1 years (range 14-70). The majority (81%) had a therapeutic laparotomy, and only 19 patients (19%) had a non-therapeutic laparotomy. The most commonly injured organs include the small bowel, stomach, colon, diaphragm, and liver. There was no significant difference in age, sex, duration of injury, systolic blood pressure and heart rate at presentation between the two groups. There were significantly more patients who presented with peritonism in the therapeutic laparotomy group compared to the non-therapeutic laparotomy group (82% vs 53%, p=0.005). Patients who presented with peritonism were six times more likely to have a therapeutic laparotomy. There was no significant difference between morbidity and mortality rates in the two groups. The length of hospital stay for the non-therapeutic laparotomy group was significantly shorter compared to the therapeutic laparotomy group (3.6 vs 5.7 days, p=0.006). Conclusion: The rate of therapeutic laparotomy remains to be significantly higher among patients with omental evisceration. Hence, omental evisceration, particularly those associated with peritonism, should continue to prompt operative management.
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spelling pubmed-68230202019-11-12 Mandatory Laparotomy in Penetrating Abdominal Injuries with Omental Evisceration: Experience in a Major Trauma Center in the Philippines De Robles, Marie Shella B Ayuste Jr, Eduardo C Cureus Emergency Medicine Background: Omental evisceration due to abdominal stab injuries connotes peritoneal penetration and translates to around 70% risk of intra-abdominal injury. Such cases are being managed with mandatory laparotomy at the Philippine General Hospital. This study aims to review the patient profile and laparotomy outcomes in such cases. Methods: This is a retrospective review of 98 consecutive laparotomies performed for patients with omental evisceration secondary to abdominal stab wounds between January 2004 to April 2018. Results: Almost all patients were male (99%) with a mean age of 32.1 years (range 14-70). The majority (81%) had a therapeutic laparotomy, and only 19 patients (19%) had a non-therapeutic laparotomy. The most commonly injured organs include the small bowel, stomach, colon, diaphragm, and liver. There was no significant difference in age, sex, duration of injury, systolic blood pressure and heart rate at presentation between the two groups. There were significantly more patients who presented with peritonism in the therapeutic laparotomy group compared to the non-therapeutic laparotomy group (82% vs 53%, p=0.005). Patients who presented with peritonism were six times more likely to have a therapeutic laparotomy. There was no significant difference between morbidity and mortality rates in the two groups. The length of hospital stay for the non-therapeutic laparotomy group was significantly shorter compared to the therapeutic laparotomy group (3.6 vs 5.7 days, p=0.006). Conclusion: The rate of therapeutic laparotomy remains to be significantly higher among patients with omental evisceration. Hence, omental evisceration, particularly those associated with peritonism, should continue to prompt operative management. Cureus 2019-09-18 /pmc/articles/PMC6823020/ /pubmed/31720157 http://dx.doi.org/10.7759/cureus.5688 Text en Copyright © 2019, De Robles et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Emergency Medicine
De Robles, Marie Shella B
Ayuste Jr, Eduardo C
Mandatory Laparotomy in Penetrating Abdominal Injuries with Omental Evisceration: Experience in a Major Trauma Center in the Philippines
title Mandatory Laparotomy in Penetrating Abdominal Injuries with Omental Evisceration: Experience in a Major Trauma Center in the Philippines
title_full Mandatory Laparotomy in Penetrating Abdominal Injuries with Omental Evisceration: Experience in a Major Trauma Center in the Philippines
title_fullStr Mandatory Laparotomy in Penetrating Abdominal Injuries with Omental Evisceration: Experience in a Major Trauma Center in the Philippines
title_full_unstemmed Mandatory Laparotomy in Penetrating Abdominal Injuries with Omental Evisceration: Experience in a Major Trauma Center in the Philippines
title_short Mandatory Laparotomy in Penetrating Abdominal Injuries with Omental Evisceration: Experience in a Major Trauma Center in the Philippines
title_sort mandatory laparotomy in penetrating abdominal injuries with omental evisceration: experience in a major trauma center in the philippines
topic Emergency Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823020/
https://www.ncbi.nlm.nih.gov/pubmed/31720157
http://dx.doi.org/10.7759/cureus.5688
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