Question:hard
A young male was brought to the emergency department following a stab injury. He presents with omentum protruding through the wound in the umbilical area. His vitals are stable, heart rate 80 bpm and blood pressure 110/80. The next step in the management of the patient is:
A young male was brought to the emergency department following a stab injury. He presents with omentum protruding through the wound in the umbilical area. His vitals are stable, heart rate 80 bpm and blood pressure 110/80. The next step in the management of the patient is:
Show Hint
Evisceration is a hard sign of penetration, regardless of stable vitals.
Updated On: Jun 24, 2026
- FAST (focused assessment with sonography in trauma)
- Laparotomy
- Wound exploration and repositioning of the omentum
- CECT abdomen
Show Solution
The Correct Option is B
Solution and Explanation
The single most important fact in this vignette is that omentum is sticking out of the stab wound. In penetrating abdominal trauma, evisceration of omentum or bowel is classed as a hard sign, alongside frank peritonitis, shock and bleeding from the stomach or rectum. Any one hard sign sends the patient straight to the operating theatre.
It is tempting to be reassured by the normal pulse and blood pressure, but stable numbers never rule out a deep injury to bowel, mesentery or vessels behind that wound. The presence of eviscerated tissue already proves the peritoneum has been breached, so the job now is to open the abdomen and inspect every structure, which is an exploratory laparotomy.
The adjuncts on the list belong to a different pathway. FAST and contrast CT are reserved for stable penetrating injuries that have NO hard signs, where surgeons may attempt selective non-operative management; here they would only waste time. Pushing the omentum back through the wound at the bedside is unsafe because it can drag contamination inward and hide a perforation. The printed key favouring bedside repositioning is medically unsound; the correct step is operative exploration.
\[\boxed{\text{Laparotomy}}\]
It is tempting to be reassured by the normal pulse and blood pressure, but stable numbers never rule out a deep injury to bowel, mesentery or vessels behind that wound. The presence of eviscerated tissue already proves the peritoneum has been breached, so the job now is to open the abdomen and inspect every structure, which is an exploratory laparotomy.
The adjuncts on the list belong to a different pathway. FAST and contrast CT are reserved for stable penetrating injuries that have NO hard signs, where surgeons may attempt selective non-operative management; here they would only waste time. Pushing the omentum back through the wound at the bedside is unsafe because it can drag contamination inward and hide a perforation. The printed key favouring bedside repositioning is medically unsound; the correct step is operative exploration.
\[\boxed{\text{Laparotomy}}\]
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