Selective non-operative management of solid organ injury following abdominal gunshot wounds.
BACKGROUND
The objective of this study was to evaluate the outcome of patients sustaining a torso gunshot wound with documented solid organ injury. Our hypothesis was that the non-operative management of isolated solid organ injuries is a safe management option for a select group of patients.


METHODS
A retrospective review of a prospectively collected database was conducted to identify all patients sustaining a torso gunshot resulting in a solid organ injury undergoing non-operative management over a 5-year period (12/1999-01/2005). Patient demographics, injury details, diagnostic imaging, outcome and follow-up were reviewed.


RESULTS
Of 644 gunshot wounds to the torso, 144 (22%) underwent non-operative management. Thirteen of these patients (9%) had 16 solid organ injuries (10 liver, 4 kidney and 2 spleen). CT characterisation of the isolated solid organ injury ranged from AAST Grade I-IV. One of 13 patients failed non-operative management and subsequently underwent laparotomy, which was non-therapeutic. Clinical follow-up was available in all patients for an average of 101 days (median 27, range 6-473). The organ salvage rate was 100%.


CONCLUSIONS
In select haemodynamically stable patients without peritonitis able to undergo serial clinical examination, solid organ injury is not a contra-indication to non-operative management. In the appropriate setting, non-operative management of solid organ injury after gunshot wounding is associated with a high rate of success and organ salvage.
DuBose
Joseph
J
Division of Trauma Surgery and Critical Care, University of Southern California, Los Angeles, CA, United States.
Inaba
Kenji
K
Teixeira
Pedro G R
PG
Pepe
Antonio
A
Dunham
Michael B
MB
McKenney
Mark
M
D000293:Adolescent; D000328:Adult; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007668:Kidney / Q000293:injuries*; D008099:Liver / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000628:therapy*