Selective non-operative management of solid organ injury following abdominal gunshot wounds

DuBose, Joseph J.; Inaba, Kenji; Teixeira, Pedro G.R.; Pepe, Antonio; Dunham, Michael; McKenney, Mark

doi:10.1016/j.injury.2007.02.030

Cited by 65 publications

(47 citation statements)

References 36 publications

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“…DuBose et al (22) reported that non-operative approach is a safe method for appropriately selected patients' solid organ injuries in abdominal gunshot wounds. They presented 9% SNOM failure with patients having solid organ injuries.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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Objective: In line with advances in diagnostic methods and expectation of a decrease in the number of negative laparotomies, selective non-operative management of abdominal gunshot wounds has been increasingly used over the last three decades. We aim to detect the possibility of treatment without surgery and present our experience in selected cases referred from Syria to a hospital at the Turkish-Syrian border. Material and Methods:Between February 2012 and June 2014, patients admitted with abdominal gunshot wounds were analyzed. Computed tomography was performed for all patients on admission. Patients who were hemodynamically stable and did not have symptoms of peritonitis at the time of presentation were included in the study. The primary outcome parameters were mortality and morbidity. Successful selective non-operative management (Group 1) and unsuccessful selective non-operative management (Group 2) groups were compared in terms of complications, blood transfusion, injury site, injury severity score (ISS), and hospital stay. Results:Of 158 truncal injury patients, 18 were considered feasible for selective non-operative management. Of these, 14 (78%) patients were treated without surgery. Other Four patients were operated upon progressively increasing abdominal pain and tenderness during follow-up. On diagnostic exploration, all of these cases had intestinal perforations. No mortality was observed in selective non-operative management. There was no statistically significant difference between Group 1 and Group 2, in terms of length of hospital stay (96 and 127 h, respectively). Also, there was no difference between groups in terms of blood transfusion necessity, injury site, complication rate, and injury severity score (p>0.05). Conclusion:Decision making on patient selection for selective non-operative management is critical to ensure favorable outcomes. It is not possible to predict the success of selective non-operative management in advance. Cautious clinical examination and close monitoring of these patients is vital; however, emergency laparotomy should be performed in case of change in vital signs and positive symptoms concerning peritonitis.Keywords: Abdominal, gunshot, non-operative management, selective INTRODUCTIONIn 1960, Shaftan (1) reported that 34.1% of patients with abdominal injury were laparotomy negative and suggested that the need for surgery in abdominal injury patients should be determined with physical examination. In his series, the non-operatively treated patients comprised mostly patients with stab wounds, but included some with gunshot wounds. The negative laparotomy rate of about 20% determined during the Vietnam War was found acceptable because of the low morbidity in laparotomy negative cases (2). Subsequently, serious objections to obligatory laparotomy were raised, and consequently, a selective conservative approach in penetrating abdominal traumas was introduced to treatment (3, 4). In 1986, Demetriades et al. (5) non-operatively treated penetrating hepatic injuries with a su...

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Section: Discussionmentioning

confidence: 99%

“…SNOM is especially recommended in solid organ injuries (22). The reason of SNOM failure cases was the presence of luminal organ injury.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…Although low-velocity gunshot wounds may be managed conservatively with a good outcome in selected stable patients [10], due to the possibility of missed injuries, missile migration and late lead intoxication, we think that pediatric patients suffering from retroperitoneal penetrating gunshot injuries should undergo bullet removal as far as possible. The treatment options for the removal of the bullet are explorative laparotomy, laparoscopy and local wound exploration.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Removal of a Paracaval Air Gun Bullet in a Child

Murányi¹,

Józsa

Benyó³

et al. 2012

Urol Int

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Air guns are known as low-velocity arms and are considered harmless. However, injuries from air weapons can be serious and even fatal, particularly in children. We present a potentially life-threatening penetrating retroperitoneal injury of a 3-year-old boy caused by an air gun, and the successful removal of the bullet via a laparoscopic approach. The patient was brought to our center with a penetrating air gunshot wound on his right side in the waist area. He was accidentally shot by his brother at their home. The patient’s clinical condition was stable. Computed tomography scan showed the bullet in the retroperitoneum near the inferior vena cava. A three-port laparoscopic transperitoneal approach was performed. The bullet was found just 0.5 cm caudal to the right renal hilum and 0.5 cm near the inferior vena cava; it was then removed. Operation time was 42 min and the postoperative course was uneventful. Thanks to improvements in laparoscopic surgical techniques, laparoscopy has become a feasible and effective treatment modality even for the removal of foreign bodies in children.

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“…It is the principal cause of death during the first half of life 1 however fall from height and physical assault also constitute a substantial percentage of these injuries. In all trauma patients, abdominal organ injuries are quite common and liver is the second most commonly injured organ in abdominal trauma 2,3 but damage to the liver is the most common cause of death after blunt abdominal injury. 2,3 The most common cause of hepatic injury is blunt abdominal trauma which is secondary to motor vehicle accidents 2,4 and is 15%-20% of blunt abdominal trauma.…”

Section: Introductionmentioning

confidence: 99%

“…In all trauma patients, abdominal organ injuries are quite common and liver is the second most commonly injured organ in abdominal trauma 2,3 but damage to the liver is the most common cause of death after blunt abdominal injury. 2,3 The most common cause of hepatic injury is blunt abdominal trauma which is secondary to motor vehicle accidents 2,4 and is 15%-20% of blunt abdominal trauma. 5 The mortality following hepatic injury has direct relation to the associated other organ injuries and it rises from about 20% to over 50% when four or more organs are involved.…”

Section: Introductionmentioning

confidence: 99%

Presentation and Management of Hepatic Injury due to Blunt Trauma in Patients Attending in Casualty Block of dmch- a Study of 50 cases

et al. 2017

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Abstract:Objective: To diagnose the cases of hepatic injury due to blunt abdominal trauma in a shortest possible time and find out the way of efficient and planned management of hepatic injury in our present setting. Materials and methods: Results: Most patients were male (88%) and 68% of patients were belonged to age group of 21 to 40 years. Most of the patients (90%) were injured as a result of road traffic accidents. All patients had a history of trauma and most of them presented with abdominal pain, tenderness muscular rigidity of abdomen and shock (38%). Only 13 (26%) patients had isolated hepatic injury. Rest of the patients had associated other organ injuries. Majority patients (46%) had

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Selective non-operative management of solid organ injury following abdominal gunshot wounds

Cited by 65 publications

References 36 publications

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

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

Laparoscopic Removal of a Paracaval Air Gun Bullet in a Child

Presentation and Management of Hepatic Injury due to Blunt Trauma in Patients Attending in Casualty Block of dmch- a Study of 50 cases

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