The bowel evisceration can cause ischemic damage due to impaired blood circulation by abdominal wall muscle contraction. If a large amount of the small bowel is eviscerated, it is to proceed to strangulation [1]. Small bowel evisceration after stab wound injury, definitive surgery at the operation room (OR) is usually preferred because of the problem related to further contamination and damage to the eviscerated bowel. In our case, although the size of the stab wound was only 5 cm, there was an obvious ischemic change to the strangulated small bowel, because more than 50 cm of ileum had been eviscerated. We decided to immediately extend the opening of the wound from 5 cm to 20 cm at the emergency room to restore blood circulation and brought the patient to the OR for definite surgery.

A 44-year-old man was presented to the emergency department with a bowel evisceration after stabbing in the left side of the abdomen. He took 33 minutes to the emergency room. His vital signs were as follows: blood pressure 90/60 mmHg, pulse rate 101 beats/min, respiration rate 20 breaths/min, body temperature 36.2ºC, oxygen saturation 96%. A large amount of small bowel was eviscerated. And eviscerated bowel showed severe ischemic change and multiple transections (Fig. 1). The systolic blood pressure decreased to 60 mmHg after admission, ischemic changed small bowel deteriorated, endotracheal tube insertion was performed 4 minutes after admission. Our emergency room have laparotomy and thoracotomy devices (operation set), so we improved the circulation by performing a stab wound extension as a decompression in the emergency department to prevent strangulation of the small bowel (Fig. 2). In addition, ligation of the bleeding arteries of the mesentery was performed. And then was rapping bowel by gauzes, abdominal skin wound by IOBAN^3M. Laboratory examination revealed WBC 9.19×10³/μl, Hb 13.6 g/dl, Platelet 226×10³/μl, Lactic acid 2.0 mmol/L, Base Excess 3.0. The patient was transferred to the operating room. The circulation of the eviscerated small bowel was improved (Fig. 3). Multiple transections were observed in the jejunum and the ileum. Therefore segmental resection and anastomosis were performed (Fig. 4). Thus, most of the small bowel could be saved except for the segment with damage caused by stab injury. The patient was discharged without any complications.

Various organ eviscerations occur after abdominal stab injury. Evisceration is recognized as an indication of immediate laparotomy [2-4]. Bowel evisceration may cause ischemic change due to circulatory problem. If a large amount of the small bowel is eviscerated, it is likely to proceed to strangulation [1]. In this case, it is important to decompress the eviscerated bowel as quickly as possible which can be exacerbated by painful abdominal wall muscle contractions. If the ischemic change is severe as like present case, it may be necessary to try decompressive wound extension in the emergency department to prevent getting worse during the transfer to the operating room.

This work was supported by Clinical Research grant from Pusan National University Hospital in 2018.

No potential conflict of interest relevant to this article was reported.