An open abdominal wound with a loop of bowel protruding: what is the BEST initial treatment?

• A. Apply dry sterile gauze pads to the wound
• B. Apply a moist sterile dressing directly to the wound and secure the moist dressing in place with a dry sterile dressing
• C. Cover with a dry sterile trauma dressing and tightly secure it in place by circumferentially wrapping roller gauze around the abdomen
• D. Gently clean the exposed loop of bowel with warm sterile saline, carefully replace it back into the wound, and cover it with a dry sterile dressing

Answer: (B)

When tissue is exposed through an open abdominal wound, the priority is to protect it from contamination and drying while preserving its viability for definitive care. The best initial approach is to place a moist sterile dressing directly over the protruding loop and then secure it with a dry sterile dressing. Keeping the bowel moist prevents desiccation injury and reduces infection risk, which helps preserve tissue health until surgery can be reached. Do not attempt to clean the exposed bowel or replace it into the wound, as manipulating and reinserting it can introduce bacteria and cause further damage. A dry dressing alone can dry out the tissue, and wrapping tightly around the abdomen can create pressure that jeopardizes blood flow and tissue viability.