Pathophysiology

The flank is the area between the anterior and posterior axillary lines, superiorly bordered by the sixth rib and inferiorly bordered by the iliac crest. Although a penetrating wound to the flank can produce intraperitoneal injury with the associated physical findings of peritonitis or hemoperitoneum with shock, it is possible that a penetrating flank wound only injures the retroperitoneal organs. A delay in diagnosis of duodenal, colonic, rectal, renal, pancreatic or major vascular injuries may result in the late appearance of septic or hemorrhagic shock.

The path of a gunshot or stab wound to the flank may track superiorly. Bullets may ricochet off the bony structures of the spine and produce a unique bullet path and injury pattern. Other intra-abdominal organs may be injured, such as the stomach or pancreas, the diaphragm, and intrathoracic organs. Inferior tracking will jeopardize the lower GI tract and colon. Treatment of these specific organ injuries is covered elsewhere in this text (see Chap 251).

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