Selective conservative management of abdominal gunshot wounds: A prospective study

Abstract

A prospective study of 111 patients with low velocity gunshot wounds of the abdomen was conducted to determine whether a policy of selective conservative management based on repeated physical examination is a safe form of treatment. Laparotomy was undertaken in 89 patients (80 per cent), seven of which were negative. Of the patients 22 (20 per cent), eight of whom were considered to have peritoneal penetration, underwent conservative management. None required delayed laparotomy. Eight patients (7 per cent) died, all deaths occurring in the positive laparotomy group. The incidence of significant intra-abdominal injury if the peritoneal cavity had been penetrated was 89 per cent. Selective conservative management may be applied safely to a limited group of patients with gunshot wounds of the abdomen.

Abdominal Trauma in Durban, South Africa: Factors Influencing Outcome

“…A policy of selective nonoperative management for both blunt and penetrating trauma has been practiced by our department for many years, [21][22][23][24] even for abdominal gunshot wounds. [24][25][26][27][28] This has become the international standard in centers handling a high trauma load.…”

“…[24][25][26][27][28] This has become the international standard in centers handling a high trauma load. 21,[28][29][30][31][32][33][34] Given the average delay between injury and hospitalization in our patients and the large number of those sustaining penetrating trauma, the absence of clinical signs is a reliable means of excluding intraabdominal injury.…”

“…3,7,9 The negative laparotomy rate of only 1.2% with zero mortality in this series is encouraging compared with the reported negative laparotomy rate of 13% to 57% [35][36][37] and the mortality rate of 6.3%. 24 Independent risk factors for morbidity, identified using logistic regression analysis, were the severity of injury, delay in undergoing surgery, a metabolic acidosis, the need for transfused blood, and admission to the ICU. It is worth noting that mathematical significance and clinical relevance do not always coincide.…”

Non-operative management of abdominal gunshot injuries: Is it safe in all cases?

“…Intra-abdominal extraluminal air can be seen (22%) patients on CT, and delayed laparotomy was performed for these patients. Patients who were in unsuccessful SNOM (Group 2) group were kept under observation for 13 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) h before surgery. Small bowel injuries were noted in three patients and small bowel-colonic injury was determined in one patient.…”

“…The follow-up procedure of abdominal gunshot injuries has been increasingly used for the past three decades. Selective non-operative management (SNOM), supported by prospective and retrospective studies, is currently a popular approach (11)(12)(13)(14)(15)(16)(17)(18)(19). Evidence supporting the practibility and safety of non-operative therapy in abdominal injuries is increasingly being reported (20,21).…”