A stab wound is a form of penetrating trauma where a sharp object pierces the skin and underlying tissues, potentially damaging deeper organs and structures. The severity is determined by the object’s trajectory and depth, which can affect major blood vessels, the heart, lungs, or abdominal organs. A successful outcome relies on a rapid, coordinated response that begins immediately. This process includes immediate on-scene treatment, acute hospital stabilization, definitive surgical repair, and structured long-term recovery, aiming to control bleeding, prevent infection, and restore health.
Immediate Care and Transport
The immediate priority at the scene is controlling external hemorrhage, the most rapid cause of death in penetrating trauma. First responders and emergency medical services (EMS) personnel apply direct, firm pressure to the wound site using sterile dressings. If bleeding on an extremity is severe and uncontrolled by pressure, a tourniquet may be applied high above the injury. For deep, narrow wounds, EMS may perform wound packing, pushing hemostatic gauze into the cavity to create internal pressure.
Never remove an object that remains impaled in the body. The object may be acting as a plug (tamponade) to a damaged vessel; removal could cause severe bleeding before the patient reaches the hospital. Responders stabilize the impaled object with bulky dressings to prevent movement during transport, noting the weapon’s details for the trauma team. Pre-hospital care follows the “scoop and run” philosophy, prioritizing rapid transport to a verified trauma center. This ensures the patient reaches the operating room, where definitive internal hemorrhage control can occur, within the “golden hour.”
Emergency Department Stabilization and Assessment
Upon arrival at the Emergency Department (ED), the trauma team initiates the Advanced Trauma Life Support (ATLS) protocol, focusing on airway, breathing, and circulation. This assessment includes securing two large-bore intravenous (IV) lines for rapid fluid resuscitation and blood transfusions to correct hemorrhagic shock. The patient’s hemodynamic status (stable or unstable, such as low blood pressure or high heart rate) is the most important factor guiding subsequent care.
For hemodynamically unstable patients, emergency surgery is often decided immediately, bypassing further diagnostic imaging to stop internal bleeding without delay. For stable patients, the trauma team uses rapid diagnostic tools to determine the extent of internal injury. The Focused Assessment with Sonography for Trauma (FAST) exam is a quick bedside ultrasound checking for free fluid, typically blood, in the abdomen and around the heart. A positive FAST exam in a stable patient often indicates the need for an operative procedure.
If the FAST exam is inconclusive or negative, and the patient remains stable, a computed tomography (CT) scan provides a detailed look at the wound tract and internal organs. The scan identifies injuries to solid organs like the liver or spleen. In some abdominal stab wound cases, a local wound exploration (LWE) is performed in the ED to determine if the knife penetrated the fascial layer into the peritoneal cavity. This procedure helps triage patients with only superficial wounds, allowing discharge and avoiding unnecessary hospital admission.
Surgical Intervention and Definitive Repair
Definitive repair takes place in the operating room, most frequently through an exploratory laparotomy, which uses a large incision to access the abdominal cavity. The surgeon systematically explores the penetrating object’s path, identifies all injured structures, controls hemorrhage, and manages contamination. The small bowel is the organ most commonly injured in abdominal stab wounds, followed by the liver and colon.
Controlling active bleeding from major vessels or solid organs is the first priority, often requiring sutures, vessel clamps, or electrocautery. Injuries to the bowel or colon present a significant infection risk, as their contents spill into the sterile abdominal cavity, classifying the wound as highly contaminated. Managing a damaged bowel involves resection, where the perforated segment is removed, followed by re-anastomosis, where the healthy ends are surgically rejoined using sutures or surgical staplers.
For liver injuries, the surgeon may use specialized sutures to compress bleeding tissue, or in severe cases, use packing procedures to apply pressure while the patient stabilizes in the intensive care unit. Once internal repairs are complete, the abdominal cavity is thoroughly irrigated with sterile saline solution to reduce the bacterial load. The external wound is meticulously cleaned and debrided (damaged tissue removed) to promote healing and prevent deep infection. Depending on contamination, the surgeon may delay final skin closure for several days, allowing the wound to heal by secondary or tertiary intention, which lowers the risk of abscess formation.
Hospital Recovery and Long-Term Healing
Following surgery, the patient is moved to a surgical ward or intensive care unit (ICU) for close post-operative monitoring. This phase focuses on maintaining hemodynamic stability, managing pain, and preventing complications like infection. Patients may require temporary drains or tubes to remove excess fluid or air, which are gradually removed as they stabilize. Prompt pain management is initiated to facilitate deep breathing and early mobilization, reducing the risk of respiratory and circulatory complications.
Infection control is maintained through broad-spectrum antibiotics, especially when a contaminated injury, such as a bowel perforation, was repaired. As the patient progresses, the focus shifts to physical recovery, which may include physical therapy if the injury involved major joints or nerves. Long-term recovery must also include attention to the psychological impact of surviving a violent injury.
Trauma survivors face an increased risk of developing post-traumatic stress disorder (PTSD), with estimates suggesting up to 21% may develop the condition within the first year. Many trauma centers now integrate mental health support, including early screening for PTSD symptoms and connecting patients with counseling services before discharge. Addressing this psychological trauma is a final component to ensure the patient can fully transition back to daily life after their physical wounds have healed.