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Lesson

Abdominal Evisceration

10 min Trauma Skip to quiz

Objective: Cover bowel that is outside the abdomen with moist sterile dressings. Do not push it back in. Stop other life-threatening bleeding before you focus on the bowel.

Why this matters

Bowel lying outside the abdomen is an evisceration. It draws attention. An artery can still be bleeding somewhere else, often in the thigh. Stop bleeding you can stop. Then cover the bowel so it stays moist. Do not push it back in. Keep the patient warm. Then finish the trauma survey.

MARCH still applies: massive hemorrhage, airway, respirations, circulation, then hypothermia and head injury. Visible bowel does not outrank bleeding you can stop.

Key points
  • Wet sterile dressings with saline and cover the bowel. Add an outer layer that holds the moisture in. Do not put dry gauze on the exposed bowel.
  • Do not push the bowel back into the abdomen. That is a hospital procedure, not a field procedure.
  • Stop other life-threatening bleeding and treat shock. Check the rest of the body. This patient needs a trauma center that can operate.
Verbalize
  • Moist sterile cover. Do not push the bowel back in.
  • MARCH still applies. Stop bleeding first.
  • This patient needs surgery.

Clinical sequence

  1. Cover the exposed bowel with saline-moistened sterile dressings. Add an outer layer so the bowel does not dry out. Do not put dry gauze directly on the exposed bowel.
  2. Leave the bowel outside the abdomen. Do not push it back in.
  3. Stop other life-threatening bleeding, treat shock, and move to a trauma center that can operate.

Teaching points

  • Do not push it back in. Leave eviscerated bowel outside the abdomen, covered and moist.
  • Keep it moist, then protect it from drying and heat loss. Use wet dressings plus an outer layer that holds the moisture in.
  • MARCH still applies. Visible bowel does not outrank a femoral artery that is still bleeding.
  • Destination: a trauma center that can operate, not a clinic.

Common errors

  • Pushing bowel back into the abdomen on scene.
  • Putting dry gauze on exposed bowel so the bowel dries and is injured.
  • Watching the belly while a thigh artery is still bleeding.

Practice

One-minute check

Your partner shows you eviscerated bowel and a spraying femoral artery. Say the first two actions in order. Then say how you cover the bowel and what you will not do to it.

Related: Massive hemorrhage first.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.

1. You find bowel on the abdominal wall (evisceration). What do you do?
2. You have a spraying femoral artery and eviscerated bowel. First move?
3. Dry gauze placed directly on exposed bowel:
4. Pushing eviscerated bowel back into the abdomen is:
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