Question:medium
A 35-year-old male presents with stab wound to the epigastrium, hypotension, and guarding. What is the immediate intervention of choice?
A 35-year-old male presents with stab wound to the epigastrium, hypotension, and guarding. What is the immediate intervention of choice?
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Penetrating abdominal trauma with hypotension and guarding = immediate exploratory laparotomy.
Updated On: May 14, 2026
- FAST
- DPL
- CT Scan
- Exploratory laparotomy
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The Correct Option is D
Solution and Explanation
Step 1: Understanding the Question:
The management of abdominal trauma depends on the patient's hemodynamic stability and clinical examination findings.
Step 2: Detailed Explanation:
Clinical Triage: The patient has a penetrating injury (stab wound) to the upper abdomen. He is hemodynamically unstable (hypotension) and has signs of peritonitis (guarding).
Indication for Surgery: According to ATLS guidelines, any patient with a penetrating abdominal injury who is hemodynamically unstable OR has clear signs of peritonitis requires immediate exploratory laparotomy.
Why not FAST/DPL? FAST (Focused Assessment with Sonography for Trauma) is used to look for fluid in blunt trauma patients who are unstable. In penetrating trauma with clear peritonitis/shock, FAST only wastes time as surgery is already indicated.
Why not CT Scan? CT scans are only for stable patients. Taking an unstable patient to the CT suite is dangerous as they may crash in the scanner where resuscitation is difficult.
Goals of Surgery: The laparotomy is performed to identify the source of bleeding, control contamination from hollow viscus injury, and repair damaged organs (e.g., liver, stomach, or major vessels).
Step 3: Final Answer:
Given the hemodynamic instability and signs of peritonitis following a penetrating wound, immediate exploratory laparotomy is mandatory.
The management of abdominal trauma depends on the patient's hemodynamic stability and clinical examination findings.
Step 2: Detailed Explanation:
Clinical Triage: The patient has a penetrating injury (stab wound) to the upper abdomen. He is hemodynamically unstable (hypotension) and has signs of peritonitis (guarding).
Indication for Surgery: According to ATLS guidelines, any patient with a penetrating abdominal injury who is hemodynamically unstable OR has clear signs of peritonitis requires immediate exploratory laparotomy.
Why not FAST/DPL? FAST (Focused Assessment with Sonography for Trauma) is used to look for fluid in blunt trauma patients who are unstable. In penetrating trauma with clear peritonitis/shock, FAST only wastes time as surgery is already indicated.
Why not CT Scan? CT scans are only for stable patients. Taking an unstable patient to the CT suite is dangerous as they may crash in the scanner where resuscitation is difficult.
Goals of Surgery: The laparotomy is performed to identify the source of bleeding, control contamination from hollow viscus injury, and repair damaged organs (e.g., liver, stomach, or major vessels).
Step 3: Final Answer:
Given the hemodynamic instability and signs of peritonitis following a penetrating wound, immediate exploratory laparotomy is mandatory.
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