Selective Nonoperative Management of Penetrating Torso Injury From Combat Fragmentation Wounds

Beekley, Alec C.; Blackbourne, Lorne H.; Sebesta, James A.; McMullin, Neil R.; Mullenix, Philip S.; Holcomb, John B.

doi:10.1097/ta.0b013e31816093d0

Cited by 50 publications

(50 citation statements)

References 30 publications

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“…The popularity of MDCT as a technique for selective nonoperative management of patients with penetrating torso trauma and the high incidence of diaphragm injury in patients with entry sites to the lower chest or thoracoabdominal region emphasize the importance of having a radiologist diagnose this injury on admission [2,6,[16][17][18][19][20][21][22][23][24][25][26][27]. Accurate diagnosis enables prompt repair of the rent and prevents delayed presentation of diaphragmatic hernias.…”

Section: Discussionmentioning

confidence: 99%

MDCT diagnosis of penetrating diaphragm injury

et al. 2009

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The purpose of the study was to determine the diagnostic sensitivity and specificity of multidetector CT (MDCT) in detection of diaphragmatic injury following penetrating trauma. Chest and abdominal CT examinations performed preoperatively in 136 patients after penetrating trauma to the torso with injury trajectory in close proximity to the diaphragm were reviewed by radiologists unaware of surgical findings. Signs associated with diaphragmatic injuries in penetrating trauma were noted. These signs were correlated with surgical diagnoses, and their sensitivity and specificity in assisting the diagnosis were calculated. CT confirmed diaphragmatic injury in 41 of 47 injuries (sensitivity, 87.2%), and an intact diaphragm in 71 of 98 patients (specificity, 72.4%). The overall accuracy of MDCT was 77%. The most accurate sign helping the diagnosis was contiguous injury on either side of the diaphragm in single-entry penetrating trauma (sensitivity, 88%; specificity, 82%). Thus MDCT has high sensitivity and good specificity in detecting penetrating diaphragmatic injuries.

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Section: Discussionmentioning

confidence: 99%

MDCT diagnosis of penetrating diaphragm injury

et al. 2009

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“…In a study, the incidence of negative or nontherapeutic laparotomy was mentioned from 15% to 30%, with 41% complication rate [11]. The surgical exploration for all penetrating abdominal injuries has been questioned in hemodynamically stable patients, with improvements in diagnostic strategies and the hope of minimizing negative laparotomies [4,12,13].…”

Section: Discussionmentioning

confidence: 98%

Benefits of CT tractography in evaluation of anterior abdominal stab wounds

Ertan

Sevim

Sarıgöz

et al. 2015

The American Journal of Emergency Medicine

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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).…”

Section: Introductionmentioning

confidence: 99%

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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Selective Nonoperative Management of Penetrating Torso Injury From Combat Fragmentation Wounds

Cited by 50 publications

References 30 publications

MDCT diagnosis of penetrating diaphragm injury

MDCT diagnosis of penetrating diaphragm injury

Benefits of CT tractography in evaluation of anterior abdominal stab wounds

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

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