title: Selective non operative management of gunshot wounds to the abdomen: a collective review.
abstract: BACKGROUND
  Over the past four decades there has been a shift from operative to selective conservatism in trauma. Selective nonoperative management (SNOM) of stab wounds to the abdomen is widely accepted in trauma centres. However, selective conservatism with gunshot wounds to the abdomen is controversial. This collective review assesses the evidence of SNOM of gunshot wounds to the abdomen.
  
  
  METHODS
  A Medline search between 1 January 1960 and 31 July 2013 was conducted identifying studies that investigated SNOM of gunshot wounds to the abdomen. Case reports, review articles and editorials were excluded. All other studies that investigated SNOM of gunshot wounds to the abdomen and its outcomes were included.
  
  
  RESULTS
  A total of 37 studies were included of which 22 were prospective, 14 were retrospective and 1 case series. A total of 21330 patients with gunshot wounds to the abdomen were included, of which 6468 (30.3%) were managed nonoperatively. Successful SNOM was possible in 5510 (85.18%) patients and 958 (14.8%) failed SNOM and underwent delayed laparotomies. SNOM reduces rates of non-therapeutic laparotomies and the associated morbidity. Special aspects reviewed include the prehospital and nursing involvement in this modality of care.
  
  
  CONCLUSIONS
  Current evidence supports SNOM of gunshot wounds to the abdomen. It is associated with a decreased rate of non therapeutic laparotomy. Careful patient selection and specially designed protocols should be established and adhered to.
authors.affiliation: Department of Surgery, UKZN, Nelson R Mandela School of Medicine, Umbilo Road, Congella.
authors.forename: Nertisha
authors.initials: N
authors.lastname: Singh
authors.affiliation: Department of Surgery and Honorary Lecturer, Nelson R Mandela School of Medicine, UKZN, PostNet 27, Private Bag X05, Malvern 4055, South Africa; Trauma Service, IALCH, Durban 4000, South Africa. Electronic address: hardcastle@ukzn.ac.za.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Hardcastle
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007813:Laparotomy; D007902:Length of Stay; D016239:MEDLINE; D010043:Outcome and Process Assessment, Health Care; D010538:Peritonitis / Q000628:therapy; D017410:Practice Guidelines as Topic; D012308:Risk Management; D013019:South Africa; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D014948:Wounds, Gunshot / Q000150:complications / Q000401:mortality / Q000601:surgery / Q000628:therapy*
keywords: Gunshot wound; Non-operative management; Outcome; Review