A stab wound to the stomach, medically described as penetrating abdominal trauma, is a severe injury that immediately threatens life. The abdominal cavity contains vital structures like major blood vessels, the liver, spleen, stomach, and intestines, all vulnerable to significant damage. The primary dangers are rapid, massive internal bleeding (hemorrhage) and contamination of the sterile abdominal space by contents from the gastrointestinal tract. Immediate, correct bystander action is necessary to stabilize the victim until emergency medical services (EMS) arrive.
Securing the Scene and Activating Emergency Services
The initial priority is ensuring the environment is safe for both the victim and the helper. If the scene is unsafe, such as during an ongoing conflict or in a hazardous location, the helper must prioritize their own safety while calling for professional assistance. Once secure, immediately contact emergency services to activate the trauma response system.
Provide the dispatcher with a precise location, the nature of the injury, and the victim’s consciousness and breathing status. This allows EMS to dispatch appropriate resources for severe trauma. While waiting, maintain verbal contact with the victim to monitor their consciousness and breathing. Reassure the victim to help keep them calm, which may slow their heart rate and potentially reduce blood loss.
Immediate First Aid for the Abdominal Wound
After activating emergency services, focus on managing the wound by controlling hemorrhage and preventing contamination. If no object is impaled, place a clean, thick dressing or cloth directly over the wound. Apply gentle, steady pressure to encourage clotting and minimize external blood loss. If the dressing becomes soaked, place a second one directly on top without removing the first, and maintain continuous pressure.
Position the victim on their back (supine) with their knees bent and supported, if possible. This position relaxes the abdominal muscles, reducing tension on the wound site and lessening discomfort. Constantly monitor for signs of shock, such as pale, cool, clammy skin, a rapid pulse, or decreased consciousness. If shock is suspected and there is no head or spine injury, gently elevate the victim’s legs 10 to 12 inches to promote blood flow to the core organs.
In some cases, internal organs (often intestine or omentum) may protrude through the wound, a condition known as evisceration. This severe complication requires specialized management to protect the exposed tissue from damage and infection. Never push the exposed organs back into the abdominal cavity, as this introduces bacteria deep into the peritoneum and can cause irreparable tissue damage.
Cover the exposed tissue immediately with a sterile or the cleanest available non-fluffy dressing, such as plastic wrap or a clean, folded sheet. The dressing must be kept moist with sterile saline solution, if available, or clean water to prevent the tissue from drying out. A dry organ surface quickly loses viability. Secure the dressing loosely with tape or a bandage to prevent the organs from moving or becoming contaminated during transport.
Critical Actions to Never Take
The most important rule in managing penetrating injury is the absolute prohibition against removing an impaled object. The object, whether a knife or glass, may be acting as a temporary plug, sealing a lacerated blood vessel. Removing it prematurely releases pressure and leads to rapid, uncontrolled internal or external hemorrhage.
If an object is embedded, stabilize it in place using bulky dressings placed around the object. Ensure the object does not shift or move during the wait or transport. Any movement can cause additional trauma to surrounding tissue, blood vessels, or internal organs. This stabilization is crucial to prevent further internal damage.
Never give the victim anything by mouth, including water, food, or pain medication. This prohibition exists because the victim will almost certainly require immediate, life-saving surgery upon arrival at the hospital. If the stomach contains food or liquids, there is a substantial risk of aspiration (inhaling stomach contents into the lungs) during anesthesia induction. Maintaining an empty stomach is necessary to prepare for the general anesthetic and the mandatory surgical procedure.
Professional Medical Care and Recovery
Upon arrival at the trauma center, care shifts from stabilization to definitive treatment, starting with rapid triage and assessment of hemodynamic stability. Patients who are unstable, show signs of shock, or have obvious evisceration are taken directly to the operating room for an exploratory laparotomy. Stable patients may undergo diagnostic tests, such as a Focused Assessment with Sonography for Trauma (FAST) exam, to quickly assess for internal fluid, usually blood.
The laparotomy involves a large incision to open the abdominal cavity, allowing the surgeon to systematically examine and repair all damaged structures. Surgeons look for injuries to hollow organs, such as the stomach and intestines, which require suturing to prevent the leakage of contents and subsequent peritonitis. Solid organs, like the liver or spleen, are managed based on the extent of the damage, which may involve direct repair or, in cases of severe, uncontrolled bleeding, removal of the spleen (splenectomy).
Selective non-operative management is sometimes used for stable patients without signs of peritonitis or evisceration. These patients are closely monitored with serial abdominal examinations by a dedicated team over 12 to 24 hours to detect subtle internal injuries. This approach prevents unnecessary surgery, reduces complication rates, and shortens the hospital stay.
Infection control is a significant part of hospital treatment, as penetrating trauma introduces external bacteria. All patients immediately receive broad-spectrum antibiotics to cover potential contamination. Following surgery and stabilization, recovery focuses on monitoring for complications, particularly sepsis. Patients often require temporary feeding tubes or intravenous nutrition until their gastrointestinal tract safely resumes normal function.