SELECTIVE NONOPERATIVE MANAGEMENT OF GUNSHOT WOUNDS OF THE ANTERIOR ABDOMEN

Citation
D. Demetriades et al., SELECTIVE NONOPERATIVE MANAGEMENT OF GUNSHOT WOUNDS OF THE ANTERIOR ABDOMEN, Archives of surgery, 132(2), 1997, pp. 178-183
Citations number
24
Categorie Soggetti
Surgery
Journal title
ISSN journal
00040010
Volume
132
Issue
2
Year of publication
1997
Pages
178 - 183
Database
ISI
SICI code
0004-0010(1997)132:2<178:SNMOGW>2.0.ZU;2-2
Abstract
Objective: To investigate the role of selective nonoperative managemen t of gunshot wounds to the abdomen. Design: A prospective, protocol-gu ided study including all gunshot wounds of the anterior abdomen. Patie nts and Methods: The patients were assessed and managed according to a written protocol. Patients with hemodynamic instability or peritoniti s or associated spinal cord or head injury or requiring a general anes thetic for an extra-abdominal injury were managed by laparotomy. The r est of the patients were selected for initial nonoperative management with serial physical examinations. Results: During a 16-month period, 309 patients with gunshot wounds of the anterior abdomen were treated. Eighteen patients in extremis (5.8%) underwent an emergency departmen t-performed thoracotomy. Another 185 patients (59.9%) met the criteria for operation and underwent a laparotomy. The incidence of nontherape utic operations was 2.2%, and that of negative operations was 8.6%. On e 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 successf ully managed nonoperatively. The overall sensitivity of the initial ph ysical 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 i njuries requiring surgical repair. Conclusion: In the appropriate envi ronment, many civilian abdominal gunshot wounds can be managed nonoper atively.