Open Wound of the Abdomen

First aid for an open abdominal wound

1. Call 911 or your local emergency number for any wound deeper than a superficial scratch.
2. Lay the person down on their back with knees bent if comfortable, which relaxes the belly muscles.
3. Stop external bleeding with firm pressure using a clean cloth. If organs are visible, press around them, not on them.
4. Leave impaled objects in place. Pad around them to stop them moving. Removing them can cause sudden severe bleeding.
5. Cover protruding organs with a clean cloth or plastic wrap moistened with clean water or saline. Do not try to push them back in.
6. Give nothing by mouth, including water or pain medicine, because surgery may be needed.
7. Keep the person warm and watch their breathing and alertness until help arrives.

What causes an open wound in the abdomen

• Stab wounds from knives or broken glass in assaults or accidents
• Gunshot wounds, which cause far more internal damage than their small entry holes suggest
• Impalement in falls onto fences, tools, rebar or branches
• Industrial and farm accidents with machinery
• Animal attacks, such as bull gores or dog bites
• Surgical wounds that reopen, called wound dehiscence, which can lead to organs bulging through
• Lacerations in car crashes from metal or glass

The medical coding phrase "unspecified open wound of the abdominal wall" simply means a wound through the skin of the belly where the exact depth or location has not been recorded.

Why abdominal wounds are dangerous

The abdominal wall is only a few centimeters thick in most people. Beneath it lie the liver, spleen, stomach, intestines, kidneys and the aorta and vena cava. A wound can cause:

• Internal bleeding from the liver, spleen or major vessels, leading to hemorrhagic shock
• Bowel perforation, which leaks gut contents into the abdomen and causes peritonitis, an infection of the lining of the belly, within hours
• Diaphragm injury from wounds in the upper abdomen, which can let organs slip into the chest
• Evisceration, where organs push out through the wound

Symptoms can be delayed. A person may look well for an hour and then deteriorate, which is why monitoring in hospital matters.

How doctors assess an abdominal wound

Trauma teams follow a set sequence: airway, breathing, circulation, then a full examination. Assessment often includes:

• FAST scan: a bedside ultrasound that looks for free blood in the belly and around the heart.
• CT scan: for stable patients, to show organ injuries, bleeding and whether the wound has crossed the abdominal lining (peritoneum).
• Local wound exploration: for some stab wounds of the front abdominal wall, the surgeon opens the wound under local anesthetic to see whether it has gone through the muscle layer.
• Blood tests: blood count, blood type and crossmatch, and lactate.
• Serial examination: repeated checks over 12 to 24 hours in selected stable patients with stab wounds.
• Laparoscopy or laparotomy: looking inside with a camera or through an open incision when injury is suspected.

Treatment

Superficial wounds

If the wound has not gone through the abdominal wall muscles, it is cleaned, any dead tissue removed, and closed with stitches or staples. A tetanus booster is given if needed. These heal like any skin laceration.

Penetrating wounds

• Emergency laparotomy is needed for anyone in shock, with evisceration, or with signs of peritonitis. The surgeon controls bleeding, repairs or removes damaged bowel, and washes out the abdomen.
• Damage control surgery is used in critically injured patients: a short operation to stop bleeding and contamination, then intensive care, then a planned return to theatre for full repair.
• Non-operative management is now standard for selected stable stab wound patients with no signs of serious injury, using close observation and CT.
• Antibiotics are given for wounds that enter the abdominal cavity, to prevent infection from gut bacteria.

Complications

• Wound infection and abscess inside the abdomen
• Peritonitis and sepsis
• Adhesions (internal scar tissue) that can later cause bowel obstruction
• Incisional hernia, a bulge through a weakened scar
• Fistula, an abnormal channel between bowel and skin
• Prolonged ileus, where the bowel is slow to start working again

Recovery

Recovery from a superficial wound takes 1 to 2 weeks. After a laparotomy, most people stay in hospital for several days to weeks, then need about 6 to 8 weeks before heavy lifting or strenuous exercise, to protect the abdominal wall from hernia. Expect follow-up to check the wound and, after bowel repairs, your digestion.

At home, watch for fever, worsening pain, a swollen belly, vomiting, redness or pus at the wound, and any bulge when you cough. These need prompt medical review.

Frequently asked questions

What causes an open wound in the abdomen?

Most are caused by stab wounds, gunshots and falls onto sharp objects. Others come from machinery accidents, animal attacks, car crashes, and surgical incisions that reopen. Any wound that goes deeper than the skin can damage organs underneath.

Is a small stab wound to the stomach serious?

It can be. The size of the skin wound does not show how deep it goes. A small blade can reach the liver, bowel or a major blood vessel. Every stab wound to the abdomen needs emergency assessment, even if the person feels well.

What should you not do with an open abdominal wound?

Do not push protruding organs back in, do not remove impaled objects, and do not give food, drink or pain pills. Cover organs with a moist clean dressing, press around the wound to control bleeding and wait for emergency help.

How long does it take to recover from an abdominal wound?

A superficial cut heals in 1 to 2 weeks. After abdominal surgery for a penetrating wound, expect several days to weeks in hospital and 6 to 8 weeks before lifting heavy objects or returning to strenuous work.

What is evisceration?

Evisceration is when abdominal organs, usually the intestines or the fatty apron called the omentum, push out through a wound. It is a surgical emergency. Cover the organs with a clean, moist cloth and call 911 or your local emergency number.