Selective nonoperative management of gunshot wounds of the anterior abdomen.
OBJECTIVE
To investigate the role of selective nonoperative management of gunshot wounds to the abdomen.


METHODS
A prospective, protocol-guided study including all gunshot wounds of the anterior abdomen.


METHODS
The patients were assessed and managed according to a written protocol. Patients with hemodynamic instability or peritonitis or associated spinal cord or head injury or requiring a general anesthetic for an extra-abdominal injury were managed by laparotomy. The test of the patients were selected for initial nonoperative management with serial physical examinations.


RESULTS
During a 16-month period, 309 patients with gunshot wounds of the anterior abdomen were treated. Eighteen patients in extremis (5.8%) underwent an emergency department-performed thoracotomy. Another 185 patients (59.9%) met the criteria for operation and underwent a laparotomy. The incidence of nontherapeutic operations was 2.2%, and that of negative operations was 8.6%. One hundred six patients (34.3%) were selected for observation. Fourteen of the initially observed patients underwent a late operation, but it was therapeutic in only 5. Overall, 92 patients (29.8%) were successfully managed nonoperatively. The overall sensitivity of the initial physical examination was 97.1%. The estimated bullet trajectory was not reliable in identifying the need for operation because of 224 patients with likely peritoneal penetration only 169 (75.4%) had significant injuries requiring surgical repair.


CONCLUSIONS
In the appropriate environment, many civilian abdominal gunshot wounds can be managed non-operatively.
Demetriades
D
D
Department of Surgery, School of Medicine, University of Southern California, Los Angeles, USA.
Velmahos
G
G
Cornwell
E
E
Berne
T V
TV
Cober
S
S
Bhasin
P S
PS
Belzberg
H
H
Asensio
J
J
D000007:Abdominal Injuries / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D002648:Child; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014948:Wounds, Gunshot / Q000628:therapy*