title: Non operative management of gunshot wounds on the right thoracoabdomen.
abstract: OBJECTIVE
  To analyze the results after the implementation of the non-operative management (NOM) of the right upper thoracoabdominal gunshot injuries protocol.
  
  
  METHODS
  Prospective study. From January 2005 to December 2011, 115 patients were included into this study. Criteria for inclusion were gunshot wound to the right thoracoabdominal region, haemodynamic stability, no signs of peritonitis, and realized CT scan. The data collected were analysed by the software EXCEL.
  
  
  RESULTS
  Among the 115 patients included in our study, the mean age was 25.8 years old (range, 14-78 years old), of whom 95.6% were male, 62.6% had thoracoabdominal injuries and 37.4% had exclusively abdominal injuries. The averages of trauma scores were RTS 7.7, ISS 14.8 and TRISS 97%. One hundred and nine patients (94.8%) had liver injury, 72 (62.6%) had diaphragm and lung injury, 28 (24.4%) had renal injury. Complications were present in 12 (10.5%) patients, 7 of these related to the thorax. The NOM failure happened in 4 (3.5%) patients, 2 of them due to bile peritonitis, 1 related to bleeding and 1 the laparotomy was unnecessary. The mean hospital stay was 9.4 days. There were 2 deaths due to associated gunshot brain injury. Sixty seven patients (58.3%) were presented in the follow-up after 2 months of trauma. The CT scan showed injury scar in 58 patients (86.5%).
  
  
  CONCLUSIONS
  NOM of the penetrating right thoracoabdominal injuries must be seen with caution. The NOM of right thoracoabdominal gunshot injuries is safe only in selected cases, followed by well-defined protocols and when performed in places that have adequate infrastructure.
authors.affiliation: Hospital Foundation of the State of Minas Gerais (FHEMIG). Belo Horizonte. MG. Brazil. sizastarling@bol.com.br
authors.forename: Sizenando Vieira
authors.initials: SV
authors.lastname: Starling
authors.forename: Bruno de Lima
authors.initials: Bde L
authors.lastname: Rodrigues
authors.forename: Marcelo Portes Rocha
authors.initials: MP
authors.lastname: Martins
authors.forename: Marcelle Souza Alves
authors.initials: MS
authors.lastname: da Silva
authors.forename: Domingos André Fernandes
authors.initials: DA
authors.lastname: Drumond
mesh_terms: D000007:Abdominal Injuries / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013898:Thoracic Injuries / Q000628:therapy*; D014948:Wounds, Gunshot / Q000628:therapy*; D055815:Young Adult