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Stab Wounds
Stab wounds to the abdomen carry potential for devastating injury, depending on
which intra-abdominal structures are involved. The extent of the injury also
depends on the type, size, and length of the weapon and on the trajectory. Major
vascular injuries pose the greatest threat; commonly injured vessels include the
intra-abdominal aorta, the inferior vena cava, the portal vein, and the hepatic
veins.
Anterior stab wounds should be explored via laparoscopy or laparotomy if
hemodynamic instability or signs of peritonitis are present, if blood is noted in the
gastric aspirate or on rectal examination, or if pneumoperitoneum or evisceration
is noted ( Fig. 103.3 ). Local exploration may be used to rule out penetration of
the peritoneum, even in minor stab wounds, but laparoscopy is a very effective
means for the evaluation of stab wounds and many minor injuries can be repaired
without open surgery.
Stab wounds to the flank or back are less readily and less quickly diagnosed
than anterior wounds; the retroperitoneal structures are more protected by
paraspinal musculature, and bleeding is often tamponaded in this area. Dorsal
stab wounds are sometimes managed nonoperatively unless hemodynamic
instability or signs of peritonitis are present, although selective laparotomy is a
common surgical strategy.

ABDOMINAL INJURIES—THE LAP BELT COMPLEX AND
CHILD ABUSE
Goals of Treatment
Occult injuries in the context of motor vehicle crashes and abusive trauma are not
unusual.
The goal of evaluation and treatment is detection of injuries; hence, the index
of suspicion must remain high.
CLINICAL PEARLS AND PITFALLS
Children who are too small for adult seat belts are at increased risk for
injuries, including intra-abdominal injuries. Fractures of the lumbar

spine may be found in association with these intra-abdominal injuries.
Blunt abdominal trauma in child abuse is uncommon but mortality rates
are as high as 50%.