Knife stab wound with omental evisceration managed conservatively with interventional support: a case report

Introduction: Penetrating abdominal stab wounds are among the most common causes of abdominal trauma worldwide. Historically, omental evisceration mandated exploratory laparotomy. However, advances in clinical assessment, imaging modalities, and close patient monitoring have enabled selective non-operative management (SNOM) in carefully selected patients. Importance: This case report highlights the role of non-laparotomy management in hemodynamically stable patients presenting with penetrating abdominal stab wounds associated with isolated omental evisceration. Avoiding non-therapeutic laparotomy may reduce morbidity, mortality, hospital stay, and healthcare costs. Case report: We report two adult male patients with penetrating abdominal stab wounds complicated by omental evisceration. Both patients were hemodynamically stable, had no signs of peritonitis, and underwent thorough clinical evaluation and contrast-enhanced computed tomography, which demonstrated no intra-abdominal visceral injury. Both were successfully managed conservatively with local wound care, omental reduction, fascial closure, antibiotics, and close serial clinical monitoring without laparotomy. Discussion: The successful non-operative management of these two patients with isolated omental evisceration suggests that SNOM is feasible in hemodynamically stable patients. SNOM offers the benefits of avoiding unnecessary laparotomy, a reduced hospital stay, and lower healthcare costs and must be supported by frequent serial abdominal examinations, extended observation periods, thorough patient education regarding warning signs, and a low threshold for surgical exploration when any clinical doubt exists. Conclusion: SNOM of penetrating abdominal stab wounds with isolated omental evisceration can be feasible and safe in carefully selected, hemodynamically stable patients with close observation.