Penetrating trauma can be commonly caused by sharp objects. We report a case of penetrating injury of abdomen caused by a fairly large sized stone which is used for sharpening the objects or weapons. It pierced through the abdominal wall musculature and caused ileal transection, mesenteric tear and gastric perforation

Baitha, K

Kamble, AT

Kaple, MN

Mahakalkar, CC

English

Cognitive Sciences ePrint Archive

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Case Report: 
Penetrating Abdominal Injury by a Large Stone. 
Authors 
Chandrashekhar C Mahakalkar, Associate Professor, Department of Surgery, Jawaharlal Nehru Medical College, Sawangi 
(Meghe), Wardha, Maharashtra, 
Ashok T Kamble, Professor, Department of Surgery, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, 
Meghali N Kaple, Post Graduate Student, JNMC, Sawangi (Meghe), Wardha, Maharashtra, 
Kanchan Baitha, Post Graduate Student, Department of Surgery, Mahatma Gandhi Institute of Medical Sciences, Sevagram, 
Maharashtra. 
Address for Correspondence 
Dr. Chandrashekhar Mahakalkar, 
Department of Surgery, 
JNMC, Sawangi (Meghe), 
Dist – Wardha, Maharashtra - 442 004, India.  
E-mail: cmahakalkar@rediffmail.com 
Citation 
Mahakalkar CC, Kamble AT, Kaple MN, Baitha K. Penetrating Abdominal Injury by a Large Stone. Online J Health Allied 
Scs. 2012;11(3):6. Available at URL:http://www.ojhas.org/issue43/2012-3-6.htm 
Open Access Archives 
http://cogprints.org/view/subjects/OJHAS.html 
http://openmed.nic.in/view/subjects/ojhas.html 
Submitted: Aug 8, 2012; Accepted: Oct 3, 2012; Published: Oct 25, 2012 
Abstract: Penetrating trauma can be commonly caused by 
sharp objects. We report a case of penetrating injury of 
abdomen caused by a fairly large sized stone which is used 
for sharpening the objects or weapons. It pierced through the 
abdominal wall musculature and caused ileal transection, 
mesenteric tear and gastric perforation. 
Keywords: Penetrating trauma; Stone; Ileal transection; 
Gastric perforation 
Introduction: 
The incidence of penetrating injuries differs from centre to 
centre but majority of them are by gunshots and sharp 
objects. The severity of the injury varies widely depending 
on the body parts involved, the characteristics of the 
penetrating object and the amount of energy transmitted to 
the tissues. Penetrating injuries with bowel evisceration are 
also known.[1] We report a case of penetrating injuries with 
bowel evisceration caused by a hard, broken piece of stone 
which was used for sharpening the objects or weapons and it 
was recovered from abdominal cavity. This particular stone 
was used for sharpening the objects or weapons launched on 
a machine to rotate. It was rotating at the speed of around 
approximately 1100 rpm, which suddenly broke down and hit 
the patient’s abdomen just at a distance of 2 feet. 
Case Report 
A 32-year-old male was brought to our trauma center with 
the history of injury to the abdomen with small bowel 
evisceration while working on the machine. At trauma center, 
he was conscious, pulse was 130/ min and blood pressure 
60/40mmHg; respiratory rate 36/min. Examination of 
abdomen demonstrated evisceration of small bowel in left 
lumber region through a defect lateral to the left rectus 
muscle. There was transaction of bowl loop with torn and 
actively bleeding mesentery. No other injury was clinically 
apparent. Patient was then shifted to operation theater 
immediately after initial resuscitation. 
 
Fig 1: The complete transection of ileum at one place with 
devascularised bowel due to destruction of underlying 
mesentery. 
 
This work is licensed under a 
Creative Commons Attribution- 
No Derivative Works 2.5 India License 
Online Journal of Health and Allied Sciences 
Peer Reviewed, Open Access, Free Online Journal 
Published Quarterly :  Mangalore, South India : ISSN 0972-5997 
Volume 11, Issue 3; Jul-Sep 2012 
2 
 
 
Fig 2: The stone recovered from the abdominal cavity, 
7.5cm in length and 2.5 cm thick weighing 499 gms 
Surgical exploration was done immediately under general 
anaesthesia which revealed a 13 x 7 cm defect in anterior 
abdominal wall in left lumber region. Proximal ileum was 
completely transected into two pieces, the underlying 
mesentery was normal. One and a half feet distal to this 
transected portion, 10 cm of ileum was gangrenous with 
complete devascularisation of bowel due to destruction of 
underlying mesentery with active bleeding from mesenteric 
vessels (Fig 1). There was also one perforation of 1 x 1 cm 
size, 15 cm distal to this gangrenous segment (American 
Association for the surgery of Trauma (AAST): Small bowel 
injury scale Grade IV).[2] The stomach was also perforated 
at its greater curvature 15 cm in length. (AAST: Stomach 
injury scale Grade III).[3] A large stone was recovered from 
the abdominal cavity lying just above the pelvic brim on right 
lateral side of common iliac and its bifurcation. The stone 
was approximately wedge shaped with outer semicircular 
edge of 13cm and inner 2cm with two side edges of 7.5cm 
and 6.5cm length and the thickness 2.5 cm and weight 499 
Gms (Fig 2). The margins of transected segments were 
refreshed and end-to-end anastomosis was done. Gangrenous 
segment was resected and both the ends were anastomed. 
Ileal and stomach perforations were closed. Abdomen was 
closed after keeping the drains. Patient recovered well except 
for wound infection at the site of entry of the stone. Patient 
was discharged on day 17 post-operative. 
Discussion 
There have been many reports of penetrating abdominal 
injury by firearms or high velocity missile. Penetrating injury 
with bowel evisceration is also known and majority is due to 
knife stab wounds.[4] There are few reported cases by 
bicycle handlebar [1], piece of a glass and as a result of blunt 
abdominal trauma.[4] This kind of penetrating injury by such 
a large stone as an industrial accident is very rare. No case is 
reported in literature of such type of injury. 
The most widely accepted theory is described by the equation 
for kinetic energy E=mv2 /2.[5] This equation emphasizes 
velocity. Any increase in velocity or mass results in an 
exponential increase in wounding potential.[6] Muscle wall 
destruction might be due to its large weight and velocity, 
which caused the perforation at its first interface. After 
entering into the abdominal cavity, by any of its surface, the 
bowel close to the abdominal wall on its path might have 
transected or as a result of crushing against the vertebral 
column.[7] It then entered the mesentery of adjacent loop and 
created a rent. Gastric perforation along its greater curvature 
was the result of blow of stone over the abdominal wall 
causing sudden increase in intraluminal pressure of full 
stomach.[8] Gastric injuries are estimated to occur in 7 to 20 
% of cases of penetrating abdominal trauma.[9] 
The patient with a penetrating injury with bowel evisceration 
requires emergency resuscitation, following standard trauma 
guidelines to optimize tissue oxygenation and fluid balance; 
eviscerated bowel should be initially wrapped in cling films 
or mopps soaked in saline to prevent heat and water loss 
through evaporation.[1] Post Operative complication includes 
haemorrhage, wound infection, anastomotic failure, fistula, 
abscess and adhesive obstruction should be watched for.[10] 
References 
1. England RJ, Dalton R, Walker J. Penetrating handlebar 
injury causing bowel evisceration. Injury 
Extra 2004;35:40-41. 
2. Moore EE, Cogbill TH, Malangoni MA, et al. Organ 
injury scaling II: pancreas, duodenum, small bowel, 
colon and rectum. J Trauma. 1990;30:1427. 
3. Moore EE, Jurkovich GJ, Knudson MM, Cogbill TH, 
Malangoni MA, Champion HR Shackford SR. Organ 
Injury Scaling VI: Extrahepatic biliary, oesophagus, 
stomach, vulva, vagina, uterus (non-pregnant), Uterus 
(Pregnant), Fallopian tube, and ovary. J Trauma. 
1995;39(6):1069-1070. 
4. Nagy K, Roberts R, Joseph K, et al. Evisceration after 
abdominal stab wounds: is laparotomy required? J 
Trauma. 1999;47:622-624. 
5. DeMuth WE Jr, Nicholas GG, Munger BL. Buckshot 
wounds. J Trauma.1978;18:53-57 
6. Hall A, Angels A. Traumatic injuries to the small 
intestine. Am Surg. 1969;35:130-134. 
7. Geoghegan T, Brush BE. The mechanism of intestinal 
perforation from nonpenetrating abdominal trauma. 
AMA. Arch Surg. 1956;3:455-464 
8. Brunsting LA, Morton JH. Gastric rupture from blunt 
abdominal trauma. J Trauma. 1987;27:887-891. 
9. Talton DS, Craig MH, Hauser CJ, Poole GV. Major 
gastroenteric injuries from blunt trauma. Ann 
Surg. 1995;61:69-73. 
10. Watts DD, Fakhry SM. Incidence of hollow viscus 
injury in blunt trauma: an analysis from 275,557 trauma 
admissions from the East multi-institutional trial. J 
Trauma. 2003;54:289–294. 


Penetrating Abdominal Injury by a Large Stone

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