Penetrating Trauma Resulting in Strangulated Small Bowel Evisceration: A Case report

Penetrating Trauma Resulting in Strangulated Small Bowel Evisceration: A Case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Penetrating Trauma Resulting in Strangulated Small Bowel Evisceration: A Case report Souhaib Atri, Maryem ben brahim, Rani el aifia, Mahdi Hammami, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4145047/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : Evisceration of the small intestine following a stab wound is a rare and life-threatening complication resulting from severe abdominal trauma. This case report presents the clinical experience of a patient with small intestine evisceration after a stab wound, providing valuable insights into clinical manifestations, management, and care outcomes of this exceptional condition. Case report We present the case of a 24-year-old patient who was the victim of a penetrating trauma, leading to the strangulated evisceration of a segment of the small bowel. Upon clinical examination revealed a right flank abdominal wound as the site of strangulated small bowel evisceration. Given these clinical findings, the decision to perform an immediate exploratory laparotomy was imperative. A midline incision was made, and an exploratory laparotomy was performed. The strangulated bowel segment was well perfused, and no additional digestive lesions were identified. Consequently, abdominal lavage was carried out. The patient's postoperative course was uneventful, and the patient was discharged on the third day after surgery. Discussion: This case report emphasizes the urgency and significance of immediate surgical intervention in post-traumatic strangulated small bowel evisceration, particularly in cases involving sharp object injuries. The rarity of this condition should not undermine its critical nature, necessitating a meticulous clinical examination for timely assessment. Laboratory and radiological tests should not delay emergency surgery, considering the time sensitivity and potential consequences like intestinal necrosis. The choice between laparotomy and laparoscopy depends on the nature and severity of the injury, with laparoscopy offering diagnostic and therapeutic benefits in select cases. Overall, this case underscores the life-saving potential of prompt surgical intervention in managing this challenging condition Conclusion Post-traumatic strangulated small bowel evisceration represents a potentially grave condition. Nevertheless, prognosis primarily hinges on the severity of accompanying injuries. In cases of isolated post-traumatic strangulated small bowel evisceration, a favorable outcome can be achieved with prompt and appropriate intervention, involving immediate emergency laparotomy to address strangulation and perform a thorough evaluation of injuries. Strangulated small bowel evisceration Penetrating stab wound Urgent surgery post-traumatic abdominal trauma Life-saving potential Figures Figure 1 Figure 2 Figure 3 Introduction Severe abdominal traumas can result in serious damage to internal organs, necessitating immediate medical intervention. These traumas often lead to evisceration of internal organs, typically associated with blunt force injuries. However, there may be exceptional cases, like the one we well described, where an assault with stab wound caused a strangulated small bowel evisceration in the victim. Case report We present the case of a 24-year-old patient with no medical history who was the victim of a penetrating stab wound. The patient was immediately transferred to our emergency department. Upon clinical examination, the patient was conscious with normal vital signs including, a blood pressure of 12/7 mmHg, a heart rate of 82 bpm, and an oxygen saturation of 98%. The abdominal examination revealed a 4 cm linear wound in the right iliac fossa associated with evisceration loop. The intestinal loop was non-reducible, painful, showed a violaceous discoloration, and mesenteric congestion .(Fig. 2 ) (Fig. 3 ) The diagnosis of a strangulated intestinal loop was retained. (Fig. 1 ). In terms of laboratory findings, the patient had a blood group type A positive, hemoglobin of 13.7 g/dl, and a prothrombin time (PT) of 90%. Given this clinical presentation, the decision was made to proceed with urgent surgery, without the need for a preoperative abdominal computed tomography. After a brief reanimation, the patient underwent a midline laparotomy. The initial operative step involved the liberation of the eviscerated intestinal loop. Given the preserved viability of the affected segment, no resection was deemed necessary. The exploration of the abdominal cavity did not reveal any organ perforations or associated gastrointestinal injuries. The patient's postoperative course was uneventful, and he was discharged on the third day following the surgical intervention. Discussion Post-traumatic strangulated small bowel evisceration is a condition that warrants a serious and immediate response from the medical community .The rarity of this condition should not diminish the significance of understanding and effectively managing it ( 1 ). Our clinical case serves as an excellent opportunity to provide a comprehensive exposition of the clinical presentation, the approach to management, and the various therapeutic options available for this unique and challenging condition. In most cases described in the literature, post-traumatic eviscerations are associated with severe injuries caused by blunt objects, resulting in evisceration of multiple internal organs. In these cases, the diagnosis is relatively straightforward, and the management involves an exploratory laparotomy aimed at resecting perforated and necrotic organs. However, in the case of a strangulated evisceration following trauma with a sharp object, as is the situation with our patient, the management is based on a meticulous clinical examination. This examination allows for the assessment of the vitality of the eviscerated organ and the search for any associated injuries. For laboratory and radiological examinations, they should not delay a potential emergency surgical intervention The clinical examination holds a central role in the assessment of patients with this condition However, laboratory tests, including hemoglobin and coagulation studies,should never become a barrier to the urgently needed surgical intervention.( 2 ) In our case time is a critical factor, and any delay, even for additional tests, can have severe consequences, leading to intestinal necrosis ( 3 ) The outcome for patients suffering from this condition is largely contingent on the extent of accompanying injuries and the timeliness of surgical intervention. In cases of isolated post-traumatic strangulated small bowel evisceration, as seen in our patient, a CT scan may not be required However, in other scenarios, it can offer a visual representation of the injury's extent.( 4 ) For cases involving stab wounds resulting in strangulated bowel, the choice between laparotomy and laparoscopy is a pivotal decision. Laparoscopy can be a valuable diagnostic tool in cases where the extent and severity of the injury are uncertain. It allows for a direct visualization of the abdominal cavity, enabling surgeons to assess the condition of the bowel, mesentery, and other organs. Where the stab wound's depth or potential internal damage is not clear, laparoscopy can help provide a precise diagnosis.( 5 ) the experiences of both the Far Eastern Memorial Hospital team ( 6 ) and Giovanni Dapri( 7 ) offer valuable perspectives on this matter. Laparoscopy can also be employed as a therapeutic intervention. If the strangulated bowel segment is accessible and the patient's condition is stable, surgeons may attempt laparoscopic reduction which can avoid the need for extensive open surgery. ( 5 ) ( 8 ) However, laparoscopy has limitations and may not be suitable for complex cases or those requiring extensive bowel resection, in which open surgery is the best option.( 8 ) ( 5 ) In our case, the patient required a laparotomy to liberate the eviscerated intestinal loop, and the postoperative course proceeded without complications. This case underscores the importance of recognizing the clinical manifestations of post-traumatic strangulated small bowel evisceration and highlights the critical role of immediate surgical intervention. Conclusion In summary, this case report underscores the vital role of immediate surgery in managing patients with post-traumatic strangulated evisceration, showcasing its life-saving potential. ( 9 ). This work has been reported in line with the SCARE criteria. ( 10 ) Declarations - Consent for publication : Written informed consent was obtained from the patients for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. - Availability of supporting data: not applicable - Acknowledgements : none - Ethics approval and consent to participate : not applicable. Our institutions “la Rabta Hospital” and “ School of Medicine of Tunis” requires no ethical approval for case reports. -Certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. - Written informed consent was obtained from all participants and from a parent and/or legal guardian. - Competing interests : All authors declare that they have no conflicts of interest. - Funding : not applicable. References Demetriades D, Rabinowitz B. A Prospective Study of 651 Patients. Ann Surg févr. 1987;205(2):129–32. Nagy K, Roberts R, Joseph K, An G, Barrett J. Evisceration after abdominal stab wounds: is laparotomy required? J Trauma oct. 1999;47(4):622–4. discussion 624–626. Shaftan GW. Indications for operation in abdominal trauma. Am J Surg mai. 1960;99(5):657–64. Maurice KK, Elfiky MA, Mashhour SN, Mansour DA, Aiad G, Milad NM. CT tractography in anterior abdominal stab wounds: a proposed algorithm. Eur J Trauma Emerg Surg oct. 2021;47(5):1553–9. Diagnostic Laparoscopy in Abdominal Stab Wounds. A Prospecti… Journal of Trauma and Acute Care Surgery [Internet]. [cité 24 oct 2023]. Disponible sur: https://journals.lww.com/jtrauma/abstract/2003/ 10000/diagnostic_laparoscopy_in_abdominal_stab_ wounds__a.9.aspx . Wu C, Lin KL, Chang YJ, Lin HF. Role of laparoscopy in management of patients with anterior abdominal stab wounds. Surg Endosc 1 déc. 2023;37(12):9173–82. Dapri G, Himpens J, Lipski D, Bruyns J, Capelluto E, Stevens E, et al. Role of Laparoscopy in the Management of Visceral Injuries Following Abdominal Stab Wounds. J Laparoendosc Adv Surg Tech déc. 2007;17(6):713–8. Kindel T, Latchana N, Swaroop M, Chaudhry UI, Noria SF, Choron RL, et al. Laparoscopy in trauma: An overview of complications and related topics. Int J Crit Illn Inj Sci. 2015;5(3):196–205. Da Silva M, Navsaria PH, Edu S, Nicol AJ. Evisceration Following Abdominal Stab Wounds: Analysis of 66 Cases. World J Surg févr. 2009;33(2):215–9. Sohrabi C, Mathew G, Maria N, Kerwan A, Franchi T, Agha RA, et al. The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines. Int J Surg Lond Engl 1 mai. 2023;109(5):1136–40. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4145047","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":289622102,"identity":"f96349bc-9f17-4b29-b229-2bfddaf62298","order_by":0,"name":"Souhaib Atri","email":"","orcid":"","institution":"Hôpital La Rabta","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Souhaib","middleName":"","lastName":"Atri","suffix":""},{"id":289622103,"identity":"acd660cd-b926-4363-a8b8-21cffdb02fed","order_by":1,"name":"Maryem ben brahim","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIie3PvQrCMBSG4ciR0yXqeqSiVyAIhaLoxQhCXNI7EB0EXdTdu3DKLBQ7Ka7dhQ5OiiA4+JOKiw5tR4e80zfkIQljJtP/1gGs+Ws9qJKVCKtI2I0Jz0r8UpV4I17ppD7dRXSWYKM9uxzDQZMzy9+skoi77bvlpUIHKzvVloF+GBciTCRrgXZB8R4yTzkSNSHuJpN9hPZd0WjCZOTIRxYS6ltyqgFIEg7eJBOJoDVXXUAeuOAtiGPqX/YiF97UE2rT8eEir8NqyfKDRKLL02fge2DK8Tg4/Q6TyWQyffUCAddCgbb/8HsAAAAASUVORK5CYII=","orcid":"","institution":"Hôpital La Rabta","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Maryem","middleName":"ben","lastName":"brahim","suffix":""},{"id":289622104,"identity":"afc87f57-9a95-480a-bd5d-027b1ba20095","order_by":2,"name":"Rani el aifia","email":"","orcid":"","institution":"Hôpital La Rabta","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rani","middleName":"el","lastName":"aifia","suffix":""},{"id":289622105,"identity":"5372b8c8-15b6-4805-871d-3fb889b5b9b9","order_by":3,"name":"Mahdi Hammami","email":"","orcid":"","institution":"Hôpital La Rabta","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mahdi","middleName":"","lastName":"Hammami","suffix":""},{"id":289622107,"identity":"b597645b-7908-4e92-a6ba-339db6086d94","order_by":4,"name":"Montassar Kacem","email":"","orcid":"","institution":"Hôpital La Rabta","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Montassar","middleName":"","lastName":"Kacem","suffix":""}],"badges":[],"createdAt":"2024-03-21 17:03:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4145047/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4145047/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54992253,"identity":"0ac06283-ed71-46ee-a9cd-849435abc1d0","added_by":"auto","created_at":"2024-04-19 17:24:45","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":102449,"visible":true,"origin":"","legend":"\u003cp\u003eEvisceration following Stab Wound: A Life-Threatening Emergency\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4145047/v1/2539028c3956a030f4f436d9.jpg"},{"id":54992251,"identity":"c19c586d-76d7-486a-b42f-3dfc735b4574","added_by":"auto","created_at":"2024-04-19 17:24:45","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":118428,"visible":true,"origin":"","legend":"\u003cp\u003eSide View of Strangulated Bowel Evisceration.\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4145047/v1/bcf422b625596382f0fe1f0b.jpg"},{"id":54992252,"identity":"ebbe0ef5-24be-4216-b793-cb43cbe5e8a9","added_by":"auto","created_at":"2024-04-19 17:24:45","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":113354,"visible":true,"origin":"","legend":"\u003cp\u003eSide View of Strangulated Bowel Evisceration.\u003c/p\u003e","description":"","filename":"Picture3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4145047/v1/4c57f1e3ca3d8af8ba27040b.jpg"},{"id":56342314,"identity":"050b1272-fa73-488b-be74-bae7370e02e5","added_by":"auto","created_at":"2024-05-13 00:31:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":461418,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4145047/v1/1e5f40f9-62ff-4fe9-b783-e2111ec23f60.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Penetrating Trauma Resulting in Strangulated Small Bowel Evisceration: A Case report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSevere abdominal traumas can result in serious damage to internal organs, necessitating immediate medical intervention. These traumas often lead to evisceration of internal organs, typically associated with blunt force injuries. However, there may be exceptional cases, like the one we well described, where an assault with stab wound caused a strangulated small bowel evisceration in the victim.\u003c/p\u003e"},{"header":"Case report","content":"\u003cp\u003eWe present the case of a 24-year-old patient with no medical history who was the victim of a penetrating stab wound. The patient was immediately transferred to our emergency department.\u003c/p\u003e \u003cp\u003eUpon clinical examination, the patient was conscious with normal vital signs including, a blood pressure of 12/7 mmHg, a heart rate of 82 bpm, and an oxygen saturation of 98%.\u003c/p\u003e \u003cp\u003eThe abdominal examination revealed a 4 cm linear wound in the right iliac fossa associated with evisceration loop. The intestinal loop was non-reducible, painful, showed a violaceous discoloration, and mesenteric congestion .(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) The diagnosis of a strangulated intestinal loop was retained. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn terms of laboratory findings, the patient had a blood group type A positive, hemoglobin of 13.7 g/dl, and a prothrombin time (PT) of 90%. Given this clinical presentation, the decision was made to proceed with urgent surgery, without the need for a preoperative abdominal computed tomography.\u003c/p\u003e \u003cp\u003eAfter a brief reanimation, the patient underwent a midline laparotomy. The initial operative step involved the liberation of the eviscerated intestinal loop. Given the preserved viability of the affected segment, no resection was deemed necessary.\u003c/p\u003e \u003cp\u003eThe exploration of the abdominal cavity did not reveal any organ perforations or associated gastrointestinal injuries.\u003c/p\u003e \u003cp\u003eThe patient's postoperative course was uneventful, and he was discharged on the third day following the surgical intervention.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePost-traumatic strangulated small bowel evisceration is a condition that warrants a serious and immediate response from the medical community .The rarity of this condition should not diminish the significance of understanding and effectively managing it (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Our clinical case serves as an excellent opportunity to provide a comprehensive exposition of the clinical presentation, the approach to management, and the various therapeutic options available for this unique and challenging condition.\u003c/p\u003e \u003cp\u003eIn most cases described in the literature, post-traumatic eviscerations are associated with severe injuries caused by blunt objects, resulting in evisceration of multiple internal organs. In these cases, the diagnosis is relatively straightforward, and the management involves an exploratory laparotomy aimed at resecting perforated and necrotic organs.\u003c/p\u003e \u003cp\u003eHowever, in the case of a strangulated evisceration following trauma with a sharp object, as is the situation with our patient, the management is based on a meticulous clinical examination. This examination allows for the assessment of the vitality of the eviscerated organ and the search for any associated injuries.\u003c/p\u003e \u003cp\u003eFor laboratory and radiological examinations, they should not delay a potential emergency surgical intervention\u003c/p\u003e \u003cp\u003eThe clinical examination holds a central role in the assessment of patients with this condition However, laboratory tests, including hemoglobin and coagulation studies,should never become a barrier to the urgently needed surgical intervention.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) In our case time is a critical factor, and any delay, even for additional tests, can have severe consequences, leading to intestinal necrosis (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe outcome for patients suffering from this condition is largely contingent on the extent of accompanying injuries and the timeliness of surgical intervention. In cases of isolated post-traumatic strangulated small bowel evisceration, as seen in our patient, a CT scan may not be required However, in other scenarios, it can offer a visual representation of the injury's extent.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFor cases involving stab wounds resulting in strangulated bowel, the choice between laparotomy and laparoscopy is a pivotal decision. Laparoscopy can be a valuable diagnostic tool in cases where the extent and severity of the injury are uncertain. It allows for a direct visualization of the abdominal cavity, enabling surgeons to assess the condition of the bowel, mesentery, and other organs. Where the stab wound's depth or potential internal damage is not clear, laparoscopy can help provide a precise diagnosis.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) the experiences of both the Far Eastern Memorial Hospital team (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) and Giovanni Dapri(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) offer valuable perspectives on this matter.\u003c/p\u003e \u003cp\u003eLaparoscopy can also be employed as a therapeutic intervention. If the strangulated bowel segment is accessible and the patient's condition is stable, surgeons may attempt laparoscopic reduction which can avoid the need for extensive open surgery. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eHowever, laparoscopy has limitations and may not be suitable for complex cases or those requiring extensive bowel resection, in which open surgery is the best option.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn our case, the patient required a laparotomy to liberate the eviscerated intestinal loop, and the postoperative course proceeded without complications.\u003c/p\u003e \u003cp\u003eThis case underscores the importance of recognizing the clinical manifestations of post-traumatic strangulated small bowel evisceration and highlights the critical role of immediate surgical intervention.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, this case report underscores the vital role of immediate surgery in managing patients with post-traumatic strangulated evisceration, showcasing its life-saving potential. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis work has been reported in line with the SCARE criteria. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e- \u003cstrong\u003eConsent for publication\u003c/strong\u003e: Written informed consent was obtained from the patients for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e- \u003cstrong\u003eAvailability of supporting data:\u003c/strong\u003e not applicable\u003c/p\u003e\n\u003cp\u003e- \u003cstrong\u003eAcknowledgements\u003c/strong\u003e: none\u003c/p\u003e\n\u003cp\u003e- \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e: not applicable. Our institutions \u0026ldquo;la Rabta Hospital\u0026rdquo; and \u0026ldquo; School of Medicine of Tunis\u0026rdquo; requires no ethical approval for case reports.\u003c/p\u003e\n\u003cp\u003e-Certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003e- Written informed consent was obtained from all participants and from a parent and/or legal guardian.\u003c/p\u003e\n\u003cp\u003e- \u003cstrong\u003eCompeting interests\u003c/strong\u003e: All authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e- \u003cstrong\u003eFunding\u003c/strong\u003e: not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDemetriades D, Rabinowitz B. A Prospective Study of 651 Patients. Ann Surg f\u0026eacute;vr. 1987;205(2):129\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNagy K, Roberts R, Joseph K, An G, Barrett J. Evisceration after abdominal stab wounds: is laparotomy required? J Trauma oct. 1999;47(4):622\u0026ndash;4. discussion 624\u0026ndash;626.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShaftan GW. Indications for operation in abdominal trauma. Am J Surg mai. 1960;99(5):657\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaurice KK, Elfiky MA, Mashhour SN, Mansour DA, Aiad G, Milad NM. CT tractography in anterior abdominal stab wounds: a proposed algorithm. Eur J Trauma Emerg Surg oct. 2021;47(5):1553\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiagnostic Laparoscopy in Abdominal Stab Wounds. A Prospecti\u0026hellip; Journal of Trauma and Acute Care Surgery [Internet]. [cit\u0026eacute; 24 oct 2023]. Disponible sur: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://journals.lww.com/jtrauma/abstract/2003/ 10000/diagnostic_laparoscopy_in_abdominal_stab_ wounds__a.9.aspx\u003c/span\u003e\u003cspan address=\"https://journals.lww.com/jtrauma/abstract/2003/10000/diagnostic_laparoscopy_in_abdominal_stab_wounds__a.9.aspx\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu C, Lin KL, Chang YJ, Lin HF. Role of laparoscopy in management of patients with anterior abdominal stab wounds. Surg Endosc 1 d\u0026eacute;c. 2023;37(12):9173\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDapri G, Himpens J, Lipski D, Bruyns J, Capelluto E, Stevens E, et al. Role of Laparoscopy in the Management of Visceral Injuries Following Abdominal Stab Wounds. J Laparoendosc Adv Surg Tech d\u0026eacute;c. 2007;17(6):713\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKindel T, Latchana N, Swaroop M, Chaudhry UI, Noria SF, Choron RL, et al. Laparoscopy in trauma: An overview of complications and related topics. Int J Crit Illn Inj Sci. 2015;5(3):196\u0026ndash;205.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDa Silva M, Navsaria PH, Edu S, Nicol AJ. Evisceration Following Abdominal Stab Wounds: Analysis of 66 Cases. World J Surg f\u0026eacute;vr. 2009;33(2):215\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSohrabi C, Mathew G, Maria N, Kerwan A, Franchi T, Agha RA, et al. The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines. Int J Surg Lond Engl 1 mai. 2023;109(5):1136\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Strangulated small bowel evisceration, Penetrating stab wound, Urgent surgery, post-traumatic abdominal trauma, Life-saving potential","lastPublishedDoi":"10.21203/rs.3.rs-4145047/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4145047/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction :\u003c/p\u003e \u003cp\u003eEvisceration of the small intestine following a stab wound is a rare and life-threatening complication resulting from severe abdominal trauma. This case report presents the clinical experience of a patient with small intestine evisceration after a stab wound, providing valuable insights into clinical manifestations, management, and care outcomes of this exceptional condition.\u003c/p\u003e \u003cp\u003eCase report\u003c/p\u003e \u003cp\u003eWe present the case of a 24-year-old patient who was the victim of a penetrating trauma, leading to the strangulated evisceration of a segment of the small bowel.\u003c/p\u003e \u003cp\u003eUpon clinical examination revealed a right flank abdominal wound as the site of strangulated small bowel evisceration. Given these clinical findings, the decision to perform an immediate exploratory laparotomy was imperative.\u003c/p\u003e \u003cp\u003eA midline incision was made, and an exploratory laparotomy was performed. The strangulated bowel segment was well perfused, and no additional digestive lesions were identified. Consequently, abdominal lavage was carried out. The patient's postoperative course was uneventful, and the patient was discharged on the third day after surgery.\u003c/p\u003e \u003cp\u003eDiscussion:\u003c/p\u003e \u003cp\u003eThis case report emphasizes the urgency and significance of immediate surgical intervention in post-traumatic strangulated small bowel evisceration, particularly in cases involving sharp object injuries. The rarity of this condition should not undermine its critical nature, necessitating a meticulous clinical examination for timely assessment. Laboratory and radiological tests should not delay emergency surgery, considering the time sensitivity and potential consequences like intestinal necrosis. The choice between laparotomy and laparoscopy depends on the nature and severity of the injury, with laparoscopy offering diagnostic and therapeutic benefits in select cases. Overall, this case underscores the life-saving potential of prompt surgical intervention in managing this challenging condition\u003c/p\u003e \u003cp\u003eConclusion\u003c/p\u003e \u003cp\u003ePost-traumatic strangulated small bowel evisceration represents a potentially grave condition. Nevertheless, prognosis primarily hinges on the severity of accompanying injuries. In cases of isolated post-traumatic strangulated small bowel evisceration, a favorable outcome can be achieved with prompt and appropriate intervention, involving immediate emergency laparotomy to address strangulation and perform a thorough evaluation of injuries.\u003c/p\u003e","manuscriptTitle":"Penetrating Trauma Resulting in Strangulated Small Bowel Evisceration: A Case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-19 17:24:40","doi":"10.21203/rs.3.rs-4145047/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0925ff92-9a5f-4b0f-a85d-2d92d548db59","owner":[],"postedDate":"April 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-22T05:32:40+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-19 17:24:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4145047","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4145047","identity":"rs-4145047","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}