SHOTGUN WOUNDS TO THE ABDOMEN

In 1963 Sherman and Parrish (Sherman RT, Parrish RA. Management of sho tgun Injuries: A Review of 152 Cases J Trauma 1963;3:76-86) classified shotgun wounds into three types based upon distance and penetration. Because distances are often unknown, we redefined Sherman's groups by pellet scatter. Type I patients had >25 cm of scatter, Type II had <25 cm but >10 cm, and Type III had <10 cm. Seventy-one abdominal shotgun wound patients were admitted over 8 years. Eight tangential wounds we re managed by local wound care. Of the remaining 63, 27 were Type I, 1 0 were Type II, and 26 Type III. Two Type II and six Type III patients died within 24 hours. All required laparotomy. Nine of the Type I pat ients required laparotomy; eight had peritoneal signs and one had prog ressive abdominal tenderness, hypotension, and intra-abdominal pellets . Eighteen Type I patients without peritoneal signs were observed with out complications. Type III patients suffered more vascular injuries a nd presented more frequently with hypotension than Type II patients. O f the patients surviving greater than 24 hours, Type IIIs received mor e transfusions and stayed longer in the intensive care unit and hospit al than Type IIs. They also suffered more complications than Type IIs. Seven Type III patients required complicated reconstruction of the ab dominal wall. Classification of abdominal shotgun injuries using pelle t spread is a more useful system in determining patient management and prognosis compared to systems based on distance. Type II and III abdo minal shot-gun injuries require laparotomy, debridement of soft tissue injuries and frequently reconstruction of abdominal wall defects. Typ e I injuries can be managed effectively using signs of peritoneal irri tation or progressive abdominal tenderness as the best indicator of th e need for operation.