ABDOMINAL EVISCERATION

ABDOMINAL EVISCERATION

1,871 estimated annual number of cases

PATTERN

births

1 in 2,229

from a Non-Traumatic oint of view

Abdominal Evisceration can also be a result of a birth defect,

(McDaniel, Stawicki & Bahner 2011)

reported incidences of approx. 1 in 40,000

Abdominal Evisceration (AE)

Traumatic Abdominal Wall Hernia (TAWH)

(McDaniel, Stawicki & Bahner 2011)

9%

abdominal wall injuries following blunt trauma

TAWH have been linked to both

HIGH-ENERGY MECHANISMS

such as traffic/pedestrian accidents,

falls from a height

and also

LOW-ENERGY MECHANISMS

such as handle bar impact

assualt

injury during recreational activities

crush.

0.2 - 1%

AE is thought to result from a simultaneous surge in abdominal pressure and a presence of shearing forces that synergistically lead to the disruption of the abdominal wall musculature and fascial layers.

The Journal of Critical Illness and Injury Sciences (2011)

Traumatic Abdominal Wall Hernia

Mechanisms of Blunt Injury

RISKS

DISTRIBUTION

(McDaniel, Stawicki & Bahner 2011)

PRIOR

- age greater than 65

- hemodynamic instability

DURING

- Increases intra-abdominal pressure

- Emergency Surgery

AFTER

- Infection of wound of abdominal cavity/wall

- hypoproteinemia and anemia

EPIDEMIOLOGY

(Dr. Trueta, J. 2005)

CONTROL

AE does not as such has a control protocol in place, however it is certainly recommended to avoid the following;

Stabbings -

MVA -

High-energy injuries -

shootings -

anything else that can cause Abdominal Trauma.

MAJOR TRAUMA CENTRES.

http://www.vesalius.com/cfoli_frms.asp?VID=1199&StartFrame=1&tnVID=1200

• Cover with sterile moistened dressing
• Cover with waterproof dressing
• Cover with towels or blanket to keep warm
• DO NOT try to replace organs into abdominal cavity

(Sanders, 2012)

PRE-HOSPITAL MANAGEMENT

PRE - HOSPITAL

MANAGEMENT

• Primary Survey- DRCAB
• Secondary survey
• Oxygenation
• Cannulation
• Consider possibility of hypovolemic shock

(Curtis & Ramsden, 2011)

Pre-hospital Managment

QUESTIONS?

DEFINITION

Abdominal Evisceration (AE)

• Major laceration occurs
• Skin and layers of the anterior abdominal wall.
• Abdominal contents in outside environment
• Predominantly from abdominal stab wounds.

da Silva, Navsaria, Edu, Nicol, as cited in Kman, Knepel, & Hays, 2012).

http://nols.blogs.com/nols_news/2008/09/eviscerationeww.html

REFERENCES:

Small Intestine: Digestion and absorption of nutrients.

Large Intestine: Reabsorption of water and storage of waste.

(Martini, Nath & Bartholomew, 2012)

The Intestines

PATHOPHYSIOLOGY

The Implications of Evisceration

• Sectioned into 4 quadrants
• Peritoneum
• Vital Organs- Liver, Spleen, Intestines

(Advanced Renal Education Program, 2013)

The Abdominal Cavity

• Electrolyte Imbalance
• Major Haemorrhage
• Dehydration
• Infection
• Infarction
• Necrosis
• Gangrene- As a result of infection

(Martini, Nath & Bartholomew, 2012:

National Cancer Institute, 2013)

Advanced Renal Education Program (2013). Anatomy of the Peritoneum . Retrieved March 20th from:

http://www.advancedrenaleducation.com/PeritonealDialysis/BasicPrinciplesofPD/

AnatomyofthePeritoneum/tabid/150/Default.aspx

Ambulance Victoria, Clinical Practice Guidelines 2012

Curtis, K., & Ramsden, C. (2011). Emergency and Trauma Care for nurses

and paramedics. New South Wales, Australia: Elsevier

Hann, E., chan, A., Bower, C., Scott, H., Clark, K., & Bryan-Scott, R. (1998). A population-based study of

abdominal wall defects in South Australia and Western Australia. Paediatric and Preinatal

Epidemiology, 12 (2)

King, K., Evans, J., & Curtis, K. (2011). Abdominal and genitourinary trauma.

In K. Cutris, & C. Ramsden (Eds.), Emergency and Trauma Care for Nurses and paramedics (1251-1288). Chatswood, Australia: Elsevier.

Kman, N., Knepel, S., & Hays. H.L. (2012). Trauma Reports. Evidence-Based

Medicine for the ED, 13 (4), 4.

Maged Ahmed Abd Elraouf, M. (2009). Body Stalk Anaomalies. Egyptian Society of Ultrasound in

Obstretics and Gynecology

Martini, F., Nath, J. & Bartholomew (2012). Fundamentals of anatomy and physiology (9th ed.). San

Francisco: Benjamin/Cummings.

McDaniel, E., Stawicki, S. P., & Bahner, D.P. (2011). Blunt Traumation Abdominal Wall Distruption with

Evisceration. International Journal of Critical Illness adn injury Science.

REFERENCES:

MedlinePlus. (2014 12-Jan). MedlinePlus Medical Dictionary. (N. L, Health, Producer)

From http://www.nlm.nih.giv/medlineplus.

National Cancer Institute (2013). Bowel Obstruction. Retrieved March 23rd from: http://www.cancer.gov/

cancertopics/pdq/supportivecare/gastrointestinalcomplications/Patient/page4

Respond Right First Aid. (2012, July 5). Respond Right Abdominal Evisceration [Video file]. Retrieved from

Sanders, M. J. (2012). Paramedic Textbook (4th ed.). St Louis, Missouri:

Elsevier 

Stewart, J., & Allen, T. (2011). Mechanisms of Injury. In K. Cutris, & C.

Ramsden (Eds.), Emergency and Trauma Care for Nurses and paramedics (1111-1168).

Chatswood, Australia: Elsevier.

Verrinder, A., & Kinsman, L. (2011). Physiology for Emergency Care.

In K. Cutris, & C. Ramsden (Eds.), Emergency and Trauma Care for Nurses and paramedics

(431-488). Chatswood, Australia: Elsevier.

and again if you would like too...

S&S

and again...

GUTTSSS

CLINICAL PRESENTATION

Haemorrhaging

Hypovolemic shock

Pale, cool, clammy, Cyanosed

Weak or thready pulse

Increase in RR

Decrease in temperature

Poor perfusion & Skin pallor

Altered level of consciousness

Visual of abdominal contents

Monitor signs of sepsis

Anxious

Pain

The more blood loss the worse the symptoms get

(King, Evans & Curtis, 2011; Verrinder, & Kinsman, 2011; Stewart, & Allen, 2011).

http://www.documentingreality.com/forum/f149/abdominal-eviceration-injury-67054/

Knife wound to the abdomen causing Evisceration.

“A wound caused by a knife to the abdominal wall causing evisceration. This was corrected via laparotomy and primary repair of intestinal injury. The patient made a good recovery and was discharged after a few days.”

http://www.trauma.org/index.php/main/images/C13/

SIGNS AND SYMPTOMS