Govindaraju Radhikaraj Coimbatore, Patil Rajesh T, Srivastava Ashish
Goa Medical College, Bambolim 403202, Goa, India.
J Forensic Leg Med. 2013 Aug;20(6):588-90. doi: 10.1016/j.jflm.2013.06.005. Epub 2013 Jul 13.
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.
自残性腹部刺伤通常并不常见，而且目前尚无关于严重自残致肠管脱出并毁损后幸存者的报道。在此，我们报告一例28岁男性患者，其在自残性腹部刺伤导致肠管脱出后2个半小时被送至医院。患者因肠系膜出血出现低血容量性休克，一段450厘米长的小肠从两处腹部刺伤伤口处被拉出，并被其多处切割。他存在酒精中毒和幻觉，似乎并未因重伤而感到疼痛或受到情绪影响。经过复苏及急诊切除吻合术后，他术后恢复顺利。在随访期间的精神科评估中，发现他患有因酒精滥用而加重的精神分裂症，并据此进行了治疗。由于自残可能是精神病发作的首发表现，因此所有自残受伤患者都有必要进行精神科评估。
