Patient case: Penetrating Intraabdominal Injury
A 29-year-old male arrives at the emergency department after sustaining a stab wound to the abdomen during an altercation. He reports severe abdominal pain and has noted increasing dizziness. On arrival, his vital signs indicate hypotension (BP 90/60 mmHg), tachycardia (HR 120 bpm), and shallow breathing. The wound is located in the left lower quadrant, with visible bleeding and a distended abdomen.
On physical examination, there is abdominal tenderness, rigidity, and absent bowel sounds. An urgent bedside ultrasound (FAST exam) reveals free fluid in the peritoneal cavity, raising concern for internal bleeding. The patient is immediately resuscitated with intravenous fluids and blood products.
Given the hemodynamic instability and findings suggestive of internal organ damage, the patient is taken to the operating room for an exploratory laparotomy. During surgery, a small bowel laceration and a punctured mesenteric artery are identified and repaired. Postoperatively, the patient is monitored in the ICU, where he remains stable after surgical intervention and blood transfusion. He gradually improves over the next few days, with no signs of infection or further complications.
a). Hypovolemic shock due to internal bleeding
b). Cardiac tamponade
c). Tension pneumothorax
d). Sepsis
a). Abdominal CT scan
b). Chest X-ray
c). FAST ultrasound
d). MRI
a). Liver and kidney
b). Spleen and pancreas
c). Small bowel and mesenteric artery
d). Stomach and diaphragm
a). Laparoscopic surgery
b). Exploratory laparotomy
c). Endoscopy
d). Conservative management with antibiotics
