Following penetrating abdominal trauma with a large loop of protruding bowel, how should you manage this injury?

• A. Apply a moist, sterile dressing covered by a dry, sterile dressing.
• B. Carefully replace the bowel and apply an occlusive dressing.
• C. Apply a tight pressure dressing to control any external bleeding.
• D. Apply a dry, sterile dressing covered by an occlusive dressing.

Answer: (A)

When bowel is protruding after penetrating abdominal trauma, the priority is to protect the exposed tissue from contamination and drying while avoiding further injury. Do not try to replace the bowel back inside the abdomen in the field, as this can introduce bacteria and cause more damage. Instead, cover the loop with a moist, sterile dressing to keep it hydrated and protected, then apply a dry, sterile dressing over it to secure and shield the area. This approach helps preserve tissue viability and reduces the risk of infection as you transport. Options that push the bowel back in, apply tight pressure, or rely on an occlusive setup without the moist coverage are not appropriate for this injury.