Abdominal stab wound in a woman with a long-term depression: A case report

Abstract text (incl. references and figure legends)

1. Case history:
A 46 year old woman with a history of depression and several suicide attempts, taken to the emergency room after stabbing herself in the abdomen with a knife.

2. Clinical findings:
BP: 110/65 mmHg, HR: 78 bpm.
Knife of 25-30cm stuck in mesogastrium with no active bleeding.

3. Research/Results:
- Eco-FAST: free liquid in Morrison's space.
- Blood test: No significant alterations except from high ethanol levels.
- CT Scan with IV contrast: sharp object with a blade of about 21.5 cm penetrating below the umbilicus, with a descending right oblique trajectory and the end in the right hemipelvis, in close contact with the sigmoid and transverse colon. Pneumoperitoneum bubbles with some perihepatic and perisplenic free fluid.

4. Diagnosis:
Penetrating abdominal trauma.

5. Therapy and Progressions:
Urgent exploratory laparotomy.
- Findings: Punctiform perforation in middle ileum.
- Surgical technique: Simple suture of the perforation.
- Uneventful recovery, discharged on the 8th postoperative day.

6. Comments:
Penetrating trauma constitutes the third cause of mortality in patients under 44 years old. Most cases reported of abdominal stab wounds occur in the left upper cuadrant¹. Most common injured organs are: small bowel (50%), large bowel (40%), liver (30%), and intra-abdominal vessels (25%)². Our case was exceptional given the minimal injuries sustained by the patient despite the dimensions of the weapon.

7. References:
1. Cowell, Christopher, and Maria E Moreira. "Initial Evaluation and Management of Abdominal Stab Wounds in Adults." UpToDate, Inc, Sept. 2022.
2. Lotfollahzadeh, Saran, and Bracken Burns. "Penetrating Abdominal Trauma." StatPearls Publishing, June 2022.

Figures:
1. Knife penetrating the abdominal cavity.
2. Punctiform perforation in middle ileum.

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