Here’s a case to test your mettle! A young male walks into the triage desk in your ED with a teensy weensy little puncture just above his umbilicus. Your triage nurse, who is very astute, recognizes that this meets your trauma activation criteria and pushes the button. The gentleman is escorted to your trauma bay and the team quickly assembles to evaluate him.

Vital signs are stable, and no other wounds are found. There is a very small 1cm stab located about 2cm above the umbilicus, perfectly in the midline. The abdomen is soft and nontender, and the patient wants to know why everyone is making such a big deal about this.

Upon close inspection of the wound, there is a very small piece of bright yellow fat protruding 2mm from the wound. It somehow doesn’t look like the subcutaneous fat around it.

Here are the questions that I’ll be addressing over the next several posts:

• What do you think of the appearance of the patient and his wound?
• Where should we go next?
• What are our diagnosis and management options?

In my next post, we’ll discuss how we diagnose this patient and whether there is a real problem here.

What do you think is going on? What is it? What do we do next? Leave a comment here, or tweet out your answers before tomorrow!