Self-inflicted stab injury with abdominal evisceration: A case report. (November 2021)

• Record Type: Journal Article
• Authors: Parajuli, Anuj; Mishra, Aakash; Ghimire, Roshan; Shrestha, Suman Kumar
• Is Part Of: International journal of surgery case reports. Volume 88(2021)
• Publication Date: 2021-11
• Subjects: Self-inflicted injury -- Abdominal evisceration -- Colon injury -- Schizoaffective disorder; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2021.106543
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction and importance: Self-inflicted abdominal stab injury with an intention of self-harm is uncommon. Moreover, self-inflicted injury leading to avulsion of the colon has rarely been reported in the literature. We report a case of a 42-years-female with schizoaffective disorder who presented with self-inflicted stab injury on the abdomen resulting in abdominal evisceration. Presentation of case: A 42-years-female with schizoaffective disorder (F25) for 10 years presented to the emergency department with multiple, self-inflicted injuries on the abdomen. A large free portion of the omentum and segment of the bowel were brought in a plastic carry bag. Examination revealed multiple transverse hesitation cuts in the epigastrium and a single deep penetrating transverse cut resulting in the evisceration of the omentum and colon. Intra-operatively, avulsion of a large portion of the greater omentum and missing segment of the mid transverse colon was observed. The patient underwent an immediate abdominal exploration and side-to-side colo-colic anastomosis along with diversion ileostomy. At three months following primary surgery, ileostomy closure was done. Conclusion: Patients with schizophrenia spectrum psychosis are at risk of self-harm and in our case a schizoaffective patient presented with self-inflicted injuries that required an emergency abdominal exploration and repair. This case highlights a multi-disciplinary approach for the management of these cases and mandates clinicians and caregivers to be more vigilant to restrict injuries in the future. Highlights: Self-inflicted abdominal stab injuries resulting in segmental transection of the transverse colon is rare. Self-inflicted injuries in psychotic patients can occur without any warning signs and despite treatment compliance. Severe injuries on the abdomen can be life threatening and requires emergent surgical management.