Effectiveness of clinical examination and radiological investigations in the success of selective non-operative management of abdominal gunshot injuries.

Abstract

Objectives: Non-operative management of abdominal gunshot injuries has become the standard care in the selected cases of modern surgery with an acceptable success rate to reduce the incidence of unnecessary laparotomies. In this study, an assessment was conducted to determine how the success of this form of management was impacted by physical examination and radiological investigation.

Material and methods: This is a retrospective study that includes all consecutive penetrating abdominal gunshot wound patients who were admitted to the emergency department between February 2011 and December 2018. All patients with superficial gunshot wounds were excluded. The decision to perform a laparotomy on injured patients was the study's primary endpoint while the discharge of patients without surgery was its secondary endpoint.

Results: Of 429 torso gunshot wound patients, 411 were males. Average age was 29.5 years. Forty-one (9.5%) were initially treated by selective nonoperative management. Five selective non-operative management patients underwent delayed laparotomy within 12 hours after admission without complication. In the end, 36 (88%) of the 41 patients were successfully treated without undergoing surgery, with only one patient developing pleural effusion and no mortality attributed to it. Of all injured patients, 45 (10.5%) patients had a negative laparotomy, with two of them subsequently developing an incisional hernia.

Conclusion: The success rate of non-operative management of torso gunshot injuries can be increased significantly in stable patients by adopting the strategy of repeated physical examinations alone or in conjunction with simultaneous radiological imaging.