Non-operative management of abdominal gunshot injuries: Is it safe in all cases?

Özet

Objective: In line with advances in diagnostic methods and expectation of a decrease in the number of negativelaparotomies, selective non-operative management of abdominal gunshot wounds has been increasingly used overthe last three decades. We aim to detect the possibility of treatment without surgery and present our experience inselected cases referred from Syria to a hospital at the Turkish-Syrian border.Material and Methods: Between February 2012 and June 2014, patients admitted with abdominal gunshot woundswere analyzed. Computed tomography was performed for all patients on admission. Patients who were hemodynamicallystable and did not have symptoms of peritonitis at the time of presentation were included in the study. Theprimary outcome parameters were mortality and morbidity. Successful selective non-operative management (Group1) and unsuccessful selective non-operative management (Group 2) groups were compared in terms of complications,blood transfusion, injury site, injury severity score (ISS), and hospital stay.Results: Of 158 truncal injury patients, 18 were considered feasible for selective non-operative management. Ofthese, 14 (78%) patients were treated without surgery. Other Four patients were operated upon progressively increasingabdominal pain and tenderness during follow-up. On diagnostic exploration, all of these cases had intestinalperforations. No mortality was observed in selective non-operative management. There was no statistically significantdifference between Group 1 and Group 2, in terms of length of hospital stay (96 and 127 h, respectively). Also,there was no difference between groups in terms of blood transfusion necessity, injury site, complication rate, andinjury severity score (p>0.05).Conclusion: Decision making on patient selection for selective non-operative management is critical to ensurefavorable outcomes. It is not possible to predict the success of selective non-operative management in advance. Cautiousclinical examination and close monitoring of these patients is vital; however, emergency laparotomy shouldbe performed in case of change in vital signs and positive symptoms concerning peritonitis.