Penetrating wounds are deceiving! They can create an "iceberg effect", where the skin is relatively unharmed except for the puncture wound(s), yet there is severe damage to underlying tissues and blood supply. Penetrating injuries to the abdomen include bites, bullets, and impalement on sticks or other items in the environment. A dog bite can exert a force of 450 psi or more, crushing tissue and perforating or lacerating organs and vasculature. A bullet sends out a wave of cavitation energy perpendicular to its path that can fracture friable tissues like the liver and spleen, even if they remain untouched by the bullet itself. Foreign material and bacteria from the penetrating object as well as the skin of the victim are carried into the wound. Additional bacteria may be released into the abdominal cavity from compromised bowel, or normal bacteria in tissues such as the liver may overgrow in areas made anaerobic from tissue necrosis.
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