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Am J Emerg Med 2018 Aug 2;36(8):1405-1409. Epub 2018 Feb 2.

Kanuni Sultan Suleyman Training and Research Hospital, Department of General Surgery, Turkey.

Introduction: The current literature and guidelines recommend that determination of peritoneal violation is done first in cases of anterior abdominal stab wounds. The primary endpoint of this study was to determine the reliability of computed tomographic (CT) tractography to assess peritoneal violation in anterior abdominal stab wounds. The secondary endpoint is to compare local wound exploration between conventional CT and CT tractography in the evaluation of peritoneal violation. Read More

World J Surg 2018 01;42(1):99-106

Department of Surgery, University of Southern California, Los Angeles, CA, USA.

Background: In hypotensive patients with thoracoabdominal penetrating injuries, trauma surgeons often face a considerable dilemma, which cavities and when to explore. We hypothesized that the Focused Assessment with Sonography for Trauma (FAST) would be accurate enough to determine the need and sequence of cavity exploration.

Methods: We conducted a 4-year retrospective study at a level 1 trauma center with high penetrating trauma volume. Read More

Emerg (Tehran) 2017 11;5(1):e34. Epub 2017 Jan 11.

Department of Emergency Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: Screening of patients with anterior abdominal penetrating trauma in need for laparotomy is an important issue in management of these cases. This study aimed to compare the accuracy of abdominal wall ultrasonography (AWU) and local wound exploration (LWE) in this regard.

Methods: This diagnostic accuracy study was conducted on ≥ 18 year-old patients presenting to emergency department with anterior abdominal stab wound and stable hemodynamics, to compare the characteristics of AWU and LWE in screening of patients in need of laparotomy. Read More

J Visc Surg 2016 Aug 16;153(4 Suppl):69-78. Epub 2016 Jun 16.

Département de Chirurgie Digestive et de l'Urgence, CHU de Grenoble, 38043 Grenoble cedex 09, France.

This is a single center retrospective review of abdominal or abdomino-thoracic penetrating wounds treated between 2004 and 2013 in the gastrointestinal and emergency unit of the university hospital of Grenoble, France. This study did not include patients who sustained blunt trauma or non-traumatic wounds, as well as patients with penetrating head and neck injury, limb injury, ano-perineal injury, or isolated thoracic injury above the fifth costal interspace. In addition, we also included cases that were reviewed in emergency department morbidity and mortality conferences during the same period. Read More

J Trauma Acute Care Surg 2016 08;81(2):307-11

From the Department of Surgery, Sefako Makgatho Health Science University, Dr George Mukhari Academic Hospital, Pretoria, South Africa.

Background: Organ evisceration after penetrating abdominal trauma (PAT) carries a high rate of significant intra-abdominal injuries. There is uniform agreement that organ evisceration warrants immediate laparotomy. Nonoperative management of stable asymptomatic patients with evisceration is associated with a high failure rate. Read More

Trauma Mon 2015 Nov 23;20(4):e24844. Epub 2015 Nov 23.

Department of Surgery, Guilan Surgery Research Center, Guilan University of Medical Sciences, Rasht, IR Iran.

Background: The current approach in stab wounds of the anterior abdominal wall is still unclear.

Objectives: The goal of this study was to evaluate serial clinical examinations of patients with abdominal wall stab wounds referred to Poursina Hospital in Rasht.

Patients And Methods: In a cross sectional study, 100 cases with stab wounds to the anterior abdominal wall were examined serially (admission time, 4, 8, 12, and 24 hours) after wound exploration. Read More

Chirurgia (Bucur) 2015 Nov-Dec;110(6):554-8

Introduction: The pancreatic injuries have fortunately a low frequency, but when present associate multiple intraabdominal lesions, and carry a significant morbidity and mortality. The aim of this study is to underline the significant morbidity associated with high grade pancreatic injuries.

Case Report: Female patient, 36 years old, with penetrating abdominal trauma due to domestic violence was referred to our center from a regional county hospital, after multiple laparotomies, hemodynamically unstable, with multiple organ failure. Read More

J Laparoendosc Adv Surg Tech A 2016 Jan 9;26(1):27-31. Epub 2015 Dec 9.

Department of General Surgery, Abassia Faculty of Medicine, Ain Shams University , Cairo, Egypt .

Background: In many trauma centers there is an ongoing controversy over the way of managing patients with penetrating abdominal injuries. This study was constructed to evaluate the role of diagnostic laparoscopy performed with local anesthesia for the management of penetrating abdominal injury.

Patients And Methods: Thirty hemodynamically stable patients with a penetrating stab wound in the anterior abdominal wall were included in this study after consent was obtained. Read More

Eur J Trauma Emerg Surg 2016 Dec 1;42(6):671-675. Epub 2015 Dec 1.

Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia.

Introduction: The management of haemodynamically stable patients who present following a penetrating abdominal injury (PAI) remains variable between mandatory surgical exploration and more selective non-operative approaches. The primary aim of this study was to assess compliance with an algorithm guiding selective non-operative management of haemodynamically stable patients with PAI. The secondary aim was to examine the association between compliance and unnecessary laparotomies. Read More

Ugeskr Laeger 2015 Oct;177(44):V12140678

A mentally ill 46-year-old woman was admitted to our hospital because of a self-inflicted stab wound to the abdomen. Diagnostic laparoscopy was performed and the peritoneum was found to be intact. She was discharged in good physical health the next day. Read More

Am Surg 2015 Oct;81(10):1034-8

Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Stab wounds (SW) to the abdomen traditionally require urgent exploration when associated with shock, evisceration, or peritonitis. Hemodynamically stable patients without evisceration may benefit from serial exams even with peritonitis. We compared patients taken directly to the operating room with abdominal SWs (ED-OR) to those admitted for serial exams (ADMIT). Read More

J Trauma Acute Care Surg 2015 Jun;78(6):1076-83; discussion 1083-5

From Department of Surgery (T.D.B), Stanford University, Stanford, California; and Division of Trauma and Critical Care (P.J.C., S.L.M., D.R.F., N.K.I., J.J.F.), University of Nevada School of Medicine, Las Vegas, Nevada.

Background: Laparoscopic techniques have evolved, allowing increased capabilities within most subspecialties of general surgery, but have failed to gain traction managing injured patients. We hypothesized that laparoscopy is effective in the diagnosis and treatment of penetrating abdominal injuries.

Methods: We retrospectively reviewed patients undergoing abdominal exploration following penetrating trauma at our Level 1 trauma center during a 6-year period from January 1, 2008, to December 31, 2013. Read More

Am J Emerg Med 2015 Sep 29;33(9):1188-90. Epub 2015 May 29.

Department of General Surgery, Kayseri Training and Research Hospital, Kayseri, Turkey. Electronic address:

Introduction: The study aimed to identify the presence of peritoneal penetration in management of anterior abdominal stab wound by using computed tomography (CT) tractography.

Material And Methods: Hemodynamically stabile, CT tractography-performed patients who were admitted to our emergency clinic with anterior abdominal stab wounds between the years 2012 and 2014 were included in this study, and all images were evaluated in terms of peritoneal penetration and possible intra-abdominal injury.

Results: In the study CT tractography identified necessity of laparotomy accurately in 90% of the patients, and none of the patients without peritoneal penetration needed surgical treatment in their follow-up. Read More

Eur J Trauma Emerg Surg 2015 Apr 1;41(2):161-6. Epub 2014 May 1.

Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg, KwaZulu Natal, 3216, South Africa,

Introduction: Retained weapon (RW) injuries are uncommon, but there is no current consensus on the best management approach.

Methods: We reviewed our experience of 102 consecutive patients with non-missile RWs in a high-volume metropolitan trauma service managed over a 10-year period.

Results: Of the 102 patients, 95 were males (93%), 7 were females (7%), and median age was 24 (21-28) years. Read More

Am Surg 2014 Oct;80(10):984-8

LAC+USC Medical Center, Division of Trauma Surgery and Surgical Critical Care, University of Southern California, Los Angeles, California, USA.

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. Read More

Am Surg 2014 Apr;80(4):403-7

Department of Surgery, Division of Trauma, Surgical Critical Care and Burns, University of California at San Diego, San Diego, California, USA.

Unlike anterior stab wounds (SW), in which local exploration may direct management, posterior SW can be challenging to evaluate. Traditional triple contrast computed tomography (CT) imaging is cumbersome and technician-dependent. The present study examines the role of CT tractography as a strategy to manage select patients with back and flank SW. Read More

Rev Col Bras Cir 2014 Jan-Feb;41(1):75-9

Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil.

The meeting of the Publication "Evidence Based Telemedicine - Trauma and Emergency Surgery" (TBE-CiTE), through literature review, selected three recent articles on the treatment of victims stab wounds to the abdominal wall. The first study looked at the role of computed tomography (CT) in the treatment of patients with stab wounds to the abdominal wall. The second examined the use of laparoscopy over serial physical examinations to evaluate patients in need of laparotomy. Read More

Arch Trauma Res 2013 1;2(1):21-5. Epub 2013 Jun 1.

Department of Surgery, Isfahan University of Medical Sciences, Isfahan, IR Iran.

Background: The optimal management of hemodynamically stable asymptomatic patients with anterior abdominal stab wounds (AASWs) remains controversial. The goal is to identify and treat injuries in a safe cost-effective manner. Common evaluation strategies are local wound exploration (LWE), diagnostic peritoneal lavage (DPL), serial clinical assessment (SCAs) and computed tomography (CT) imaging. Read More

J Trauma Acute Care Surg 2013 Dec;75(6):1013-7; discussion 1017-8

From the University of Tennessee Health Science Center, Memphis, Tennessee.

Background: The National Institute of Medicine's report Hospital-Based Emergency Care: At the Breaking Point highlighted the critical issue of emergency department overcrowding. At our institution, patients with anterior abdominal stab wounds (AASW) have been managed with a protocol that uses diagnostic laparoscopy (DL) after positive result on local wound exploration. Patients with negative DL result are eligible for discharge directly from the recovery room. Read More

World J Emerg Surg 2013 Aug 9;8(1):31. Epub 2013 Aug 9.

School of medicine and pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP: 1893; km2,200, route de sidi Hrazem, Fez 30000, Morocco.

Appendicitis and trauma may exist together, which causes an interesting debate whether trauma has led to appendicitis. We report a case of appendicitis after an abdominal trauma. Our patient developed acute appendicitis following a stab wound in the right iliac fossa. Read More

Ulus Travma Acil Cerrahi Derg 2013 Jan;19(1):53-7

Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey.

Background: Penetrating abdominal trauma (PAT) has been traditionally treated by exploratory laparotomy (EL). The aim of our study was to examine the use of diagnostic laparoscopy (DL) in the management of hemodynamically stable patients with PAT.

Methods: A prospective study was performed to compare the outcomes of hemodynamically stable patients with suspected intra-abdominal injuries due to abdominal stab wounds who underwent either EL or DL. Read More

Ann Ital Chir 2013 Jan-Feb;84(1):11-8

Aim: The authors analyse clinical cases of penetrating thoracic, abdominal, perineal and anorectal injury and describe the traumatic event and type of lesion, the principles of surgical treatment, the complication rate and follow up.

Materials And Methods: In the last 24 months, we analyzed 10 consecutive cases of penetrating thoracic and abdominal wounds [stab wound (n=7), with evisceration (n=4), gunshot wound (n=1)], and penetrating perineal and anorectal wounds (impalement n=4). In addition, we report an unusual case of neck injury from a stab wound. Read More

World J Surg 2013 May;37(5):1162-8

Department of General Surgery, Faculty of Medicine Jordan University of Science and Technology (JUST), P.O. Box 3030, Irbid, Jordan.

Background: With the progressive use of new diagnostic techniques, the management of penetrating abdominal stab wounds is changing. Most studies have been conducted in well-equipped trauma centers in developed countries, and there is a paucity of reports from general teaching hospitals with limited resources. We reviewed the assessment of anterior abdominal stab wounds in patients presenting to our hospital hoping to establish an evidence-based algorithm for managing such patients in busy general hospitals. Read More

J Trauma 2011 Dec;71(6):1494-502

Department of Surgery, Denver Health Medical Center/University of Colorado, Denver, Colorado 80204-4507, USA.

Unlabelled: The optimal management of stable patients with anterior abdominal stab wounds (AASWs) remains a matter of debate. A recent Western Trauma Association (WTA) multicenter trial found that exclusion of peritoneal penetration by local wound exploration (LWE) allowed immediate discharge (D/C) of 41% of patients with AASWs. Performance of computed tomography (CT) scanning or diagnostic peritoneal lavage (DPL) did not improve the D/C rate; however, these tests led to nontherapeutic (NONTHER) laparotomy (LAP) in 24% and 31% of cases, respectively. Read More

J Emerg Med 2012 Jul 1;43(1):190-5. Epub 2011 Nov 1.

Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina, USA.

Background: The recent mandate for surgical exploration for all penetrating abdominal trauma has been questioned. High-volume centers report good outcomes for non-operative treatment in penetrating trauma for hemodynamically stable patients without peritonitis and with tangential wounds. The applicability of this strategy in smaller hospitals is unknown. Read More

J Inj Violence Res 2012 Jan 16;4(1):42-3. Epub 2011 Apr 16.

Division of General Surgery, Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.

A 23 year old man presented with intestinal evisceration from stab injury to the left side of the abdomen with a hand-held cow horn at a local night party. He complained of severe abdominal pain and bleeding at the site of injury. He was hemodynamically stable. Read More

Injury 2011 May;42(5):478-81

Metropolitan Trauma Service Pietermaritzburg, Department of General Surgery, Nelson R Mandela School of Medicine, University of Kwa-Zulu Natal, South Africa.

Introduction: In the setting of the hypovolaemic patient with a thoraco-abdominal stab wound and potential injuries in both the chest and abdomen, deciding which cavity to explore first may be difficult.Opening the incorrect body cavity can delay control of tamponade or haemorrhage and exacerbate hypothermia and fluid shifts. This situation has been described as one of double jeopardy. Read More

J Trauma 2010 Mar;68(3):721-33

Division of Trauma, Critical Care, and Burns, Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA.

Background: : Although there is no debate that patients with peritonitis or hemodynamic instability should undergo urgent laparotomy after penetrating injury to the abdomen, it is also clear that certain stable patients without peritonitis may be managed without operation. The practice of deciding which patients may not need surgery after penetrating abdominal wounds has been termed selective management. This practice has been readily accepted during the past few decades with regard to abdominal stab wounds; however, controversy persists regarding gunshot wounds. Read More

Surg Laparosc Endosc Percutan Tech 2010 Feb;20(1):42-5

Department of Surgery, Sakarya Medical School, Sakarya University, Sakarya, Turkey.

Background: Left thoracoabdominal stab wounds (LTSWs) leading to diaphragmatic injuries can cause serious morbidity and mortality. The diagnosis and treatment of LTSWs are controversial. This study investigated the reliability of laparoscopy for the diagnosis and treatment of diaphragmatic lacerations in hemodynamically stable patients with an LTSW, hypothesizing that laparoscopy is sufficient for diagnosing and treating diaphragmatic injury after an LTSW. Read More

Injury 2010 May 12;41(5):488-91. Epub 2009 Nov 12.

Pietermaritzburg Metropolitan Complex, Department of General Surgery, University of Kwa-Zulu Natal, Nelson R Mandela School of Medicine, South Africa.

Unlabelled: Selective non-operative management based on clinical assessment has been shown to be a generally safe approach in the management of penetrating stab wounds of the torso. However there will be a subset of patients who fail selective non-operative management. This audit focuses on the failures. Read More

J Emerg Med 2011 Feb 2;40(2):188-9. Epub 2009 Oct 2.

Section of Emergency Ultrasound, Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware, USA.

Background: Emergency physicians commonly perform Focused Assessment with Sonography for Trauma (FAST) examinations to evaluate for free intraperitoneal fluid. Many ultrasound findings can be misinterpreted as free fluid, resulting in false-positive FAST examinations.

Objectives: To describe a previously unreported ultrasound finding that can be misinterpreted as free intraperitoneal fluid. Read More

J Trauma 2009 Sep;67(3):589-95

Laboratory of Surgical Pathophysiology Investigation (Lim 62), Department of Trauma, Hospital das Clínicas, University of Sao Paulo Medical School, São Paulo, Brazil.

Background: The high missed occult small bowel injuries (SBI) associated with laparoscopy in trauma (LIT) is a major reason why some surgeons still preclude LIT today. No standardized laparoscopic examination for evaluation of the peritoneal cavity is described for trauma. The objective of this article is to verify if a systematic standardized laparoscopic approach could correctly identify SBI in the peritoneal cavity for penetrating abdominal trauma (PAT). Read More

J Trauma 2009 Sep;67(3):583-8

Department of Surgery, University of California San Francisco-East Bay, Alameda County Medical Center, Oakland, California 94602, USA.

Background: We have used single-contrast (intravenous contrast only) computed tomography (SCCT) for triaging hemodynamically stable patients with penetrating torso trauma. We hypothesized that SCCT safely determines the need for operative exploration. Furthermore, trauma surgeons without specialized training in body imaging can accurately apply this modality. Read More

Interact Cardiovasc Thorac Surg 2009 Aug 25;9(2):195-7; discussion 197-8. Epub 2009 May 25.

Department of Thoracic Surgery and Endoscopic & Minimal Invasive Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Patients with a thoracoabdominal stab wound may have hidden diaphragmatic injuries that could finally lead to chronic diaphragmatic hernia. In this study, we analyzed 30 patients with penetrating thoracoabdominal injuries that were stable hemodynamically and did not need emergency exploration. They underwent thoracoscopy in order to find a probable diaphragmatic injury from March 2005 to October 2007. Read More

J Trauma 2009 May;66(5):1294-301

Department of Surgery, Denver Health Medical Center/University of Colorado-Denver, Denver, Colorado 80204-4507, USA.

Background: The optimal management of hemodynamically stable, asymptomatic patients with anterior abdominal stab wounds (AASWs) remains controversial. The goal is to identify and treat injuries in a safe, cost-effective manner. Common evaluation strategies include local wound exploration (LWE)/diagnostic peritoneal lavage (DPL), serial clinical assessments (SCAs), and computed tomography (CT) imaging. Read More

Ann Ital Chir 2008 Nov-Dec;79(6):399-407

Department of Emergency, Maggiore Hospital, AUSL Bologna, Bologna, Italy.

Background: The incidence of penetrating abdominal trauma in Western Europe is low. While non-operative management of blunt trauma has become the gold standard, the management of penetrating trauma is still controversial. Nonoperative management (NOM) and laparoscopy are currently used in selected patients, reducing the rate of unnecessary laparotomy. Read More

Ulus Travma Acil Cerrahi Derg 2009 Mar;15(2):109-12

Department of Surgery, Lutheran Medical Center, Brooklyn, New York, USA.

Background: To determine the role of a combined laparoscopic exploration and lavage (LELA) in abdominal stab wounds (ASW). We hypothesized that peritoneal penetration (PP) is not an indication for exploratory laparotomy (EL) if LELA is negative.

Methods: A prospective study (Jan 2002-Dec 2003) was carried at our Level I Trauma Center. Read More

Am J Surg 2009 Aug 12;198(2):223-6. Epub 2009 Mar 12.

Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St., MC 0206, Denver, CO 80204, USA.

Background: Recent guidelines do not support local wound exploration (LWE) or diagnostic peritoneal lavage (DPL) in the evaluation of patients with anterior abdominal stab wounds (AASWs), favoring computed tomography scanning or serial examinations. In patients without immediate indications for laparotomy, we hypothesized that LWE/DPL would identify patients requiring surgery while limiting unnecessary hospital admissions.

Methods: Patients sustaining penetrating trauma at our level I trauma center over a 3-year period were reviewed. Read More

J Laparoendosc Adv Surg Tech A 2007 Dec;17(6):713-8

Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium.

Background: Laparoscopy offers several advantages in the treatment of abdominal stab wounds. In this paper, we report our experience during 2004, where hemodynamically stable patients with stab wounds were managed laparoscopically.

Patients And Methods: Between January and December 2004, 8 hemodynamically stable patients (7 men, 1 woman) underwent laparoscopy for anterior abdominal stab wounds. Read More

S Afr J Surg 2007 Nov;45(4):128-30, 132

Trauma Centre, Department of Surgery, Groote Schuur Hospital, and Faculty of Health Sciences, University of Cape Town.

Background: The modern management of abdominal stab wounds remains controversial and subject to continued reappraisal. In the present study we reviewed patients with abdominal stab wounds to examine and validate a policy of selective non-operative management with serial physical abdominal examination in a busy urban trauma centre with a high incidence of penetrating trauma.

Methods: Over a 12-month period (2005), the records of all patients with abdominal stab wounds were reviewed. Read More

Orv Hetil 2007 Aug;148(32):1521-3

Fovárosi Onkormányzat Uzsoki utcai Kórház Sebészeti, Ersebészeti Osztály.

The authors present the case of a 29-year-old female with stab wound to the abdomen. After the initial fluid resuscitation and preliminary radiographic examinations immediate laparotomy was indicated due to hypovolaemic circulatory collapse. Splenectomy and gastric suture were necessary. Read More

Harefuah 2007 May;146(5):345-8, 406-7

Department of Urology. Sapir Medical Center, Kfar Saba.

Introduction: Penetrating renal trauma has been treated traditionally by renal exploration. In view of the successful outcome of nonoperative treatment of major blunt renal trauma, there has been a gradual shift in the approach to penetrating renal injuries, in selected cases. This study reviews the local experience with the conservative approach to penetrating renal injuries. Read More

ANZ J Surg 2007 Aug;77(8):614-20

Trauma Department, Liverpool Hospital, Sydney, New South Wales, Australia.

Clinical practice guidelines have been shown to improve the delivery of care. Anterior abdominal stab wounds, although uncommon, pose a challenge in both rural and urban trauma care. A multidisciplinary working party was established to assist in the development of evidence-based guidelines to answer three key clinical questions: (i) What is the ideal prehospital management of anterior abdominal stab wounds? (ii) What is the ideal management of anterior abdominal stab wounds in a rural or urban hospital without an on-call surgeon? (iii) What is the ideal emergency management of stable patients with anterior abdominal stab wounds when surgical service is available? A systematic review, using Cochrane method, was undertaken. Read More

Emerg Med Australas 2007 Jun;19(3):269-75

The Alfred Emergency & Trauma Centre, and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

Objectives: Australasian trauma centres receive relatively low numbers of penetrating injuries from stabbings. There is limited agreement regarding protocols to guide the management of haemodynamically stable patients with penetrating injuries. This has resulted in a wide variation in practice with anecdotally high negative laparotomy rates. Read More

Int Braz J Urol 2007 Mar-Apr;33(2):142-8, discussion 149-50

Division of Trauma Surgery, School of Medicine, State University of Campinas, Unicamp, Campinas, Sao Paulo, Brazil.

Objective: The purpose of this series is to report our experience in managing ureteral trauma, focusing on the importance of early diagnosis, correct treatment, and the impact of associated injuries on the management and morbid-mortality.

Materials And Methods: From January 1994 to December 2002, 1487 laparotomies for abdominal trauma were performed and 20 patients with ureteral lesions were identified, all of them secondary to penetrating injury. Medical charts were analyzed as well as information about trauma mechanisms, diagnostic routine, treatment and outcome. Read More

J Laparoendosc Adv Surg Tech A 2007 Apr;17(2):219-22

Division of Trauma and Surgical Critical Care, University of Massachusetts Medical School, Worcester, MA, USA.

We describe the case of a 48-year-old woman who underwent emergent diagnostic and therapeutic laparoscopy after sustaining two self-inflicted abdominal stab wounds. After evacuation of approximately 1.5 L hemoperitoneum, a through-and-through liver injury with active bleeding was locally packed with hemostatic agents (Surgicel and Avitene) to achieve successful hemostasis. Read More

Cir Cir 2006 Nov-Dec;74(6):425-9

Unidad de Cirugía Esofagogástrica, Servicio de Cirugía General, Hospital Universitario Miguel Servet de Zaragoza, España.

Background: Traumatic diaphragmatic rupture is an infrequent lesion usually found in polytrauma cases or after violent attacks. Patients are usually males between 20 and 50 years old, and car accidents are the main causes in Europe. Preoperative diagnosis must be based on a high level of suspicion and appropriate radiological explorations. Read More