title: Successful selective nonoperative management of abdominal gunshot wounds despite low penetrating trauma volumes.
abstract: OBJECTIVE
  To determine whether selective nonoperative management of abdominal gunshot wounds (AGSW) is safe in trauma centers with a low volume of penetrating trauma.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Academic level 1 trauma center with approximately 10% penetrating trauma.
  
  
  METHODS
  All patients with anterior and posterior AGSW (January 1, 1999, through December 31, 2009), excluding tangential injuries, transfers, and deaths in the emergency department. Patients with hemodynamic instability or peritonitis received an urgent laparotomy. The remaining patients had selective nonoperative management. A delayed laparotomy was offered for worsening symptoms or worrisome computed tomography findings.
  
  
  METHODS
  Hospital stay, complications, and mortality.
  
  
  RESULTS
  Of 125 AGSW patients, 38 (30%) were initially managed by selective nonoperative management (25 of 99 anterior and 13 of 26 posterior AGSW patients). Seven selective nonoperative management patients received delayed laparotomy as late as 11 hours after admission. At the end, 30 of the 125 patients (24%) were successfully managed without an operation (20 of 99 anterior and 10 of 26 posterior AGSW patients). There were no predictors of delayed laparotomy and no complications or mortality attributed to it. Ten patients (8%) had a nontherapeutic laparotomy, and 3 of them developed complications.
  
  
  CONCLUSIONS
  Selective nonoperative management of AGSW is feasible and safe in trauma centers with low penetrating trauma volumes. Nearly 1 in 4 AGSW patients does not need a laparotomy, and nontherapeutic laparotomies are associated with complications. The volume of AGSW per se should not be an excuse for routine laparotomies. These data become particularly important because penetrating trauma volumes are decreasing around the country.
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge St, Ste 810, Boston, MA 02114, USA. kfikry@partners.org
authors.forename: Karim
authors.initials: K
authors.lastname: Fikry
authors.forename: George C
authors.initials: GC
authors.lastname: Velmahos
authors.forename: Athanasios
authors.initials: A
authors.lastname: Bramos
authors.forename: Sumbal
authors.initials: S
authors.lastname: Janjua
authors.forename: Marc
authors.initials: M
authors.lastname: de Moya
authors.forename: David R
authors.initials: DR
authors.lastname: King
authors.forename: Hasan B
authors.initials: HB
authors.lastname: Alam
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000465:Algorithms; D005260:Female; D006465:Hemoperitoneum / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008404:Massachusetts; D018579:Patient Selection; D010538:Peritonitis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D055815:Young Adult