Page 143 - JSOM Winter 2021

There exists no definitive study or clinical trials to address • Re-evisceration – In the event of re-evisceration
prehospital management of abdominal evisceration. Cur- (hernia) remove the skin closure and cover the evis-
rent recommendations will necessarily be based on expe- cerated organs as recommended in 12b.
rienced surgical opinion and extrapolated causes of death • If no known endpoint exists for surgical care, con-
from the aforementioned studies. sider attempting reduction as long as there is no
5. Does a requirement exist for a novel wound management gastric/intestinal fluid or stool leakage.
device to best manage abdominal evisceration?
Prehospital management of abdominal evisceration can References
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care considerations, there is a need for a bowel bag with hour.” Wilderness Environ Med. 2017;28(2S):S135–S139.
adjustable base ring that adheres to skin, allowing for a 3. Rasmussen TE, Baer DG, Cap AP, Lein BC. Ahead of the curve:
more durable, longer-term dressing application. sustained innovation for future combat casualty care. J Trauma
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Approved Change to the TCCC Guidelines tality in trauma patients with hemorrhage from torso injury occurs
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Current Wording 1105. doi:10.1016/j.amjsurg.2016.08.018
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a. Inspect and dress known wounds grands blesses, de shock nerveux, hemorragique ou infectieux; II.
Du role joue par l’hemorragie dans l’apparation du shock trau-
b. Abdominal evisceration – [Control bleeding]; rinse matique; III. Analyses d’observations. Bull Med Soc Chir (Par).
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static dressing or hemostatic agent to uncontrolled fection Crit Care. 1978;18(9) suppl 6:635–643.
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• Reduction: do not attempt if there is evidence of 12. Kotwal RS, Howard JT, Orman JA, et al. The effect of a golden
ruptured bowel (gastric/intestinal fluid or stool hour policy on the morbidity and mortality of combat casualties.
leakage) or active bleeding. JAMA Surg. 2016 Jan;151(1):15–24.
• If no evidence of bowel leakage and hemorrhage is 13. George MJ, Adams SD, McNutt MK, et al. The effect of dam-
visibly controlled, a single brief attempt (<60 sec- age control laparotomy on major abdominal complications: a
matched analysis. Am J Surg. 2018;216(1):56–59.
onds) may be made to replace/reduce the eviscer- 14. De Robles S, Ayuste E. Mandatory laparotomy in penetrating
ated abdominal contents. abdominal injuries with omental evisceration: experience in a
• If successful, reapproximate the skin using avail- major trauma center in the Philippines. Cureus. 11(9):e5688.
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a chest seal (other examples include suture, staples, 15. Petersen K, Riddle MS, Danko JR, et al. Trauma-related infections
in battlefield casualties from Iraq. Ann Surg. 2007;245:803– 811.
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• If unable to reduce; cover the eviscerated organs gery during recent US combat operations from 2002 to 2016. J
with water impermeable nonadhesive material Trauma Acute Care Surg. 2018 Jul;85(1S Suppl 2): S122–S128.
(transparent preferred to allow ability to reassess 17. Olorundare EO, et al. Abdominal injuries in communal crises: the
Jos experience. J Emerg Trauma Shock. 2016 Jan–Mar;9(1):3–9.
for ongoing bleeding); examples include a bowel 18. Stebbings WS, Chalstrey LJ, Gilmore OJ, et al. Stab injury: the
bag, IV bag, clear food wrap, etc. and secure the experience of an East London Hospital 1978–1983. Postgrad
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• Do NOT FORCE contents back into abdomen or nal stab wounds: is laparotomy required? J Trauma. 1999;47(4):
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• The patient should remain NPO. 20. Kong VY, et al. Selective nonoperative management of abdominal
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• It is OK to attempt reduction if a patient presents injuries. J Trauma. 2011;71(2 Suppl 2):S270–S281.
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