00:01
Now, we’ve discussed blunt injury,
let’s talk about penetrating injury.
00:06
Penetrating injury in the United
States has decreased significantly.
00:09
In fact, most trauma centers
see 85% blunt injury patients.
00:12
This is good for our patients.
00:15
Now, penetrating abdominal injuries
are a little bit different than blunt
in the sense that they are more at risk
for perforation and may require surgery.
00:24
In fact, most penetrating
abdominal surgeries
require at least a
diagnostic laparoscopy.
00:30
That’s in the hope of avoiding a major
exploratory laparotomy incision
particularly if the exploratory
laparotomy may turn out to be negative.
00:41
Now, remember, if there is a
question of peritoneal violation,
which is the indication for surgery, you
can always offer a diagnostic laparoscopy.
00:49
Small little incisions take a look
at it while the patient is asleep.
00:52
Or alternatively, you can do what’s
called a local wound exploration.
00:56
I have to say particularly in
obese patients, it’s easier said
than done in the trauma bay but
it can be done under local.
01:03
If you notice that there
is peritoneal violation or
suspect it, the patient needs
to have an exploration.
01:09
Now, let me pose another
clinical scenario.
01:11
What if patient is stabbed from the
left flank with a butcher’s knife?
What are some
potential injuries?
I’ll give you a second
to think about it.
01:23
Let’s go over the
potential injuries.
01:25
I hope you kept these in mind.
01:27
Clearly, anything on the left
flank can injure the kidney,
colon,
small intestines,
aorta, and the ureter.
01:36
Now, in this image, you
see a colon injury.
01:41
What are your priorities?
Well, in the operating room
if done in a timely manner,
there should be very little
contamination or spillage of stool,
but our main goal is actually controlling
the contamination and maintain stability.
01:55
If all those cases are in a relatively
clean and controlled situation,
there’s nothing wrong with
just putting a suture and
closing the hole depending
on how big the hole is.
02:05
In all penetrating colon surgeries
prior to making incision,
the patient should get
pre-operative antibiotics.
02:12
Remember, you can close the hole primarily
if there is very minimal spillage.
02:15
No drains are usually necessary.
02:18
However, this is not the case if
there’s a lot of contamination.
02:22
In these situations with significant
contamination either a blood or a stool,
patient may need a
temporizing ostomy.
02:31
Here you see an ostomy.
02:32
Remember, tell the
patient it’s temporary.
02:34
And with significant stool spillage,
I recommend you leave some drains.