Self-inflicted Abdominal Stab Wounds Research Articles

Are Self-Inflicted Stab Wounds Less Severe Than Assaults? Analysis of Injury and Severity by Intent

BackgroundAlthough there is evidence that self-inflicted abdominal stab wounds are less severe than those from assault, it is unclear if this is true in other anatomic regions. This study compares severity and injury pattern between self-inflicted stab wounds (SISWs) and wounds from assault (ASW). Materials and MethodsStab wounds from our level I trauma registry from 2013 to 2018 were reviewed. Data included age, gender, self-inflicted versus assault, psychiatric or substance use history, anatomic location, operative intervention, injury severity, length of stay, and outcomes. ResultsOver the study period, 1390 patients were identified. History of psychiatric diagnoses or previous suicide attempts was more frequent in SISWs (47% versus 6.5%, P < 0.01; 35% versus 0.4%, P < 0.01). SISWs had a higher incidence of wounds to the neck and abdomen (44% versus 11%, P < 0.01; and 34% versus 26%, P = 0.02). Overall, injuries from ASW had a higher injury severity score, but more procedures were performed on SISWs (46% versus 34%, P < 0.01). SISWs to the neck were more likely to undergo procedures (26% versus 15%, P = 0.04). Median hospital charges were higher in patients with SISWs ($58.6 K versus $39.4 K, P < 0.01). ConclusionsSISWs have a distinct pattern of injuries, more commonly to the neck and abdomen, when compared with injuries resulting from ASW. The patients with SISWs have a higher rate of procedures, longer length of stay, and higher hospital charges despite low injury severity overall.

Should the management approach to the anterior abdominal stab wound be different in patients with self-inflicted abdominal injury?

BackgroundSelf-inflicted injury is a leading cause of death worldwide. It is hypothesized that due to instincts for self-preservation, the severity of abdominal injury would be decreased following suicidal self-stabbing in comparison to stab wounds from assault, and therefore a more conservative management might be considered. MethodsAll patients with isolated abdominal stab wound (SW) admitted to 19 Trauma Centers in Israel between the years 1997 and 2018 were included in the study. Patients with self-inflicted abdominal SW (Group I) were compared to victims with abdominal SW following assault (Group II). ResultsGroup I included 9.4% (314/3324) of patients eligible for this study. Compared to Group II, Group I patients were older (median: 39 years, IQR 28,52 vs. 24 years, IQR 19,33; p<0.001), had more females (28.7% vs 4.9%, p <0.001), had longer length of hospitalization (median: 3 days vs. 2 days; p<0.001), underwent surgery more frequently (55.4% vs. 37.4%; p<0.001), and had higher mortality (2.9% vs. 0.7%; p=0.003). Possible covariates for mortality were examined and following logistic regression, self-inflicted injury remained associated with higher death rates compared to assault (OR 4.027, CI95% 1.380, 11.749; p=0.011). ConclusionIn this study, patients with isolated self-inflicted abdominal injuries had higher mortality and more frequently underwent abdominal surgery.

A fatal case of self-inflicted abdominal stab wound

In general, suicide by stab wound is rare especially among females and often challenges the medico-legal acumen of an autopsy surgeon while deciding the manner of death. In this report, we present a case of a 46 year old woman found dead in her home with a single abdominal stab wound. No other injury including hesitation wounds was found during autopsy. History given by the relatives revealed that she was mentally unstable and was suffering from a chronic illness. The death was labeled a suicide based on the findings observed during autopsy along with those found at the crime scene and the personal history of the victim.

Self-Inflicted Abdominal Stab Wounds Have a Higher Rate of Non-therapeutic Laparotomy/Laparoscopy and a Lower Risk of Injury.

The profile and management of self-inflicted abdominal stab wounds (SI-ASW) patients is still obscure. The National Trauma Data Bank (2012) was queried for adults with abdominal stab wounds (n=9544). Patients with SI-ASW (n=1724) and non-SI-ASW (n=7820) were compared. Predictors for non-therapeutic laparotomy/laparoscopy (non-TL) in SI-ASW patients were identified. SI-ASW patients were older, had more females and behavioral disorders, similar physiology, but a lower Injury Severity Score. They had more laparotomies overall (54 versus 48%, p<0.0001) and more non-TL (42 versus 32%, p<0.0001), but less injuries (43 versus 53%, p<0.0001), although peritoneal violation rate was similar. Complications and mortality were similar. In the SI-ASW cohort, non-TL patients were more likely to be female and younger, and to have Glasgow Coma Scale (GCS) ≥13 and a higher systolic blood pressure. History of psychiatric, drug and alcohol disorders was associated with SI-ASW, but did not independently predict the need for treatment in adjusted models. Patients with SI-ASW underwent more non-TL than patients with non-SI-ASW. Female gender, younger age, and a higher GCS and systolic blood pressure predicted non-TL in this group.

Self-inflicted Abdominal Stab Wound Causing Penetrating Injury of the Duodenum and Pancreatic Head: A Case Report

Self-inflicted Abdominal Stab Wound Causing Penetrating Injury of the Duodenum and Pancreatic Head: A Case Report

Successfully treated bizarre self-mutilation with disembowelment – Case report with review of literature

Self-inflicted abdominal stab wounds are generally uncommon and there is no published report of survivors after extensive self inflicted disembowelment with mutilation. Here we present a case of 28 year old male who was brought to hospital 2 1/2 h after disembowelment through self inflicted abdominal stab injuries. The patient had hypovolemic shock due to bleeding from the mesentery and a 450 cm segment of small bowel which had been pulled out from 2 abdominal stab wounds and slashed multiple times by him. He had alcohol intoxication and hallucinations and did not seem to be in pain or emotionally affected by the severe injury. After resuscitation, and emergency resection with anastomosis he had an uneventful post-operative recovery. On psychiatric evaluation during follow-up, he was found to have schizophrenia aggravated by alcohol abuse and was treated accordingly. As self mutilation can be the first presentation of a psychotic episode, a psychiatric evaluation is necessary for all patients with self inflicted injuries.

The Comparison of Characteristic and Clinical Features of Self-Inflicted Abdominal Stab Wound Patients in Japan: Simple Stab Wounds Versus Hara-kiri Wounds

The proportion of suicide attempts by infliction of abdominal stab wounds (ASWs) is higher in Japan than in other counties. There are few clinical reports on these wounds, especially hara-kiri wounds, which involve transversely cutting the abdomen. This study aimed to investigate Japanese patients with self-inflicted hara-kiri wounds and determine their characteristics and clinical features. We investigated 84 patients with self-inflicted ASWs who had been transferred to our hospital between April 1994 and March 2004. We recorded their characteristics and clinical features. They were then divided into two groups depending on their wound type, namely, simple stab wounds (SSWs) and hara-kiri wounds. The characteristics and clinical features of each group were then compared. SSWs were frequently observed in the periumbilical and epigastric regions, whereas most hara-kiri wounds were observed in the middle abdomen. The rate of organ injury was 58.7% (44 of 75) for SSWs and 66.7% (6 of 9) for hara-kiri wounds; no significant difference was observed in this regard. SSWs resulted in injury to various organs, whereas hara-kiri wounds typically caused small bowel, mesenterium, omentum, and major vascular injuries. Small bowel and major vascular injuries had a significantly high incidence in hara-kiri wounds. The mortality rate caused by hara-kiri wounds was significantly higher than that caused by SSWs (1.3% vs. 22.2%). The mortality rate caused by ASWs is relatively low. However, hara-kiri wounds might be a risk factor for death. Further, because hara-kiri wounds transversely cut the abdomen, they might be a risk factor for major vascular injury.

Inferior vena caval injury following self-inflicted abdominal stab wound

A rare case of attempted suicidal abdominal stabbing using a shoemaker's piercing awl is reported. The patient presented with the weapon still in place. On emergency exploration, injury to the inferior vena cava and the inferior mesenteric artery were found. The case highlights the fact that major vascular injury may be present in patients of abdominal stabs with retained weapons inspite of their haemodynamic stability. It also illustrates the importance of manipulating retained weapons only after complete exposure with adequate preparation for a vascular procedure.

Laparoscopic Management of Penetrating Liver Trauma: A Safe Intervention for Hemostasis

We describe the case of a 48-year-old woman who underwent emergent diagnostic and therapeutic laparoscopy after sustaining two self-inflicted abdominal stab wounds. After evacuation of approximately 1.5 L hemoperitoneum, a through-and-through liver injury with active bleeding was locally packed with hemostatic agents (Surgicel and Avitene) to achieve successful hemostasis. The patient also underwent systematic exploration of the abdominal cavity, which was free of associated injury. She had an uneventful recovery. This case adds to the growing evidence supporting the role of therapeutic laparoscopy in the safe management of carefully selected stable patients with penetrating abdominal trauma.

Self-inflicted abdominal stab wounds

Background: Self-inflicted abdominal stab wounds (ASWs) are uncommon. The present study aims to characterize the clinical profile of this unique group of psychiatric–surgical patients. Methods: A retrospective review of 23 patients with intentional self-inflicted ASWs at two urban level I trauma centres during a 10-year period. Results: Most patients were males (70%), ages ranging from 21 to 82 years (mean 40 years). Seventy-four percent of patients had a previous psychiatric history and prior suicide attempts were common (41%). Half of the patients had a positive admission drug or alcohol screen. Hypotension (systolic blood pressure (SBP) <90mmHg) was present in only two patients. Mean injury severity, revised trauma and Glasgow coma scores were 5.8, 7.7 and 14.5, respectively. The most commonly used instrument was a knife (87%). There were 1.5 external wounds per patient located primarily in the right upper quadrant (40%) and right lower quadrant (23%). These were associated with extra-abdominal wounds in 22% of cases. Local wound exploration was positive in 15 patients (65%), who all underwent laparotomy. Injured intra-abdominal or retroperitoneal organs were identified in 10 patients and included the stomach, duodenum, small bowel, colon, mesentery, inferior vena cava (IVC) and psoas muscle with a mean of 1.7 injuries per patient. Wound infection was the only post-operative complication (two patients). All eight patients with a negative local wound exploration were observed without complication. Seventy percent of patients were ultimately transferred to a psychiatric ward with a mean length of stay on the surgical service of 8 days. Only one patient died during admission due to metastatic malignant disease. Conclusion: Self-inflicted ASWs in suicidal patients can induce significant although most likely non-lethal abdominal and retroperitoneal injuries. This observation should guide the trauma surgeon when treating such patients.