• D Demetriades, G Velmahos, E Cornwell, T V Berne, S Cober, P S Bhasin, H Belzberg, and J Asensio.
• Department of Surgery, School of Medicine, University of Southern California, Los Angeles, USA.
• Arch Surg Chicago. 1997 Feb 1; 132 (2): 178-83.

ObjectiveTo investigate the role of selective nonoperative management of gunshot wounds to the abdomen.DesignA prospective, protocol-guided study including all gunshot wounds of the anterior abdomen.Patients And MethodsThe 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.ResultsDuring 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.ConclusionIn the appropriate environment, many civilian abdominal gunshot wounds can be managed non-operatively.

16 keywords...

hide…