Abdominal Stab Wounds-Abdominal Gunshot Wounds-Paracentesis of the Abdomen

Abdominal Stab Wounds

The  stab wounds in the Abdomin  may or may not penetrate the parietal peritoneum and violate the peritoneal cavity and consequently may or may not significantly damage the abdominal viscera. The structures in the various layers through which an abdominal stab wound penetrates depend on the anatomic location.

Lateral to the rectus sheath are the following: skin, fatty layer of superficial fascia, membranous layer of superficial fascia, thin layer of deep fascia, external oblique muscle or aponeurosis, internal oblique muscle or aponeurosis, transversus abdominis muscle or aponeurosis, fascia transversalis, extraperitoneal connective tissue (often fatty), and parietal peritoneum.

Anterior to the rectus sheath are the following: skin, fatty layer of superficial fascia, membranous layer of superficial fascia, thin layer of deep fascia, anterior wall of rectus sheath, rectus abdominis muscle with segmental nerves and epigastric vessels lying behind the muscle, posterior wall of rectus sheath, fascia transversalis, extraperitoneal connective tissue (often fatty), and parietal peritoneum.

In the midline are the following: skin, fatty layer of superficial fascia, membranous layer of superficial fascia, thin layer of deep fascia, fibrous linea alba, fascia transversalis, extraperitoneal connective tissue (often fatty), and parietal peritoneum. In an abdominal stab wound, washing out the peritoneal cavity with saline solution (peritoneal lavage) can be used to determine whether any damage to viscera or blood vessels has occurred.

Abdominal Gunshot Wounds

Gunshot wounds are much more serious than stab wounds; in most patients, the peritoneal cavity has been entered, and significant visceral damage has ensued.

Paracentesis of the Abdomen

Paracentesis of the abdomen cab be used  to withdraw excessive collections of peritoneal fluid, as in ascites secondary to cirrhosis of the liver or malignant ascites secondary to advanced ovarian cancer. Under a local anesthetic, a needle or catheter is inserted through the anterior abdominal wall. The underlying coils of intestine are not damaged because they are mobile and are pushed away by the cannula.

 If the cannula is inserted in the midline , it will pass through the following anatomic structures: skin, superficial fascia, deep fascia (very thin), linea alba (virtually bloodless), fascia transversalis, extraperitoneal connective tissue (fatty), and parietal peritoneum.

If the cannula is inserted and above the deep circumflex artery lateral to the inferior epigastric artery, it will pass through the following: skin, superficial fascia, deep fascia (very thin), aponeurosis or muscle of external oblique, internal oblique muscle, transversus abdominis muscle, fascia transversalis, extraperitoneal connective tissue (fatty), and parietal peritoneum