A 27-year-old man has a stab wound in the left lower quadrant through which omentum protrudes. He is haemodynamically stable with a soft abdomen. While preparing him for theatre, what is the correct handling of the eviscerated omentum?

• A Gently return it into the peritoneal cavity and close the skin defect
• B Leave it exposed and apply topical povidone iodine every 10 minutes
• C Cover it with dry gauze and apply an abdominal binder
• D Cover it with moist sterile gauze and do not attempt replacement ✓

Explanation

Evisceration of omentum or bowel from a penetrating abdominal wound is itself an absolute indication for laparotomy. Until theatre, the protruding viscus is covered with moist sterile saline gauze to prevent desiccation and contamination. Bowel or omentum must never be forced back at the bedside because this seeds peritoneal contamination and can injure adherent structures. Dry dressings adhere to serosa and cause tearing on removal.

Reference: ATLS Student Course Manual, American College of Surgeons, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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