Successful selective nonoperative management of abdominal gunshot wounds despite low penetrating trauma volumes

Karim Fikry*, George C. Velmahos, Athanasios Bramos, Sumbal Janjua, Marc De Moya, David R. King, Hasan B. Alam

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

Objective: To determine whether selective nonoperative management of abdominal gunshot wounds (AGSW) is safe in trauma centers with a low volume of penetrating trauma. Design: Retrospective study. Setting: Academic level 1 trauma center with approximately 10% penetrating trauma. Patients: All patients with anterior and posterior AGSW (January 1, 1999, through December 31, 2009), excluding tangential injuries, transfers, and deaths in the emergency department. Patients with hemodynamic instability or peritonitis received an urgent laparotomy. The remaining patients had selective nonoperative management. A delayed laparotomy was offered for worsening symptoms or worrisome computed tomography findings. Main Outcome Measures: Hospital stay, complications, and mortality. Results: Of 125 AGSW patients, 38 (30%) were initially managed by selective nonoperative management (25 of 99 anterior and 13 of 26 posterior AGSW patients). Seven selective nonoperative management patients received delayed laparotomy as late as 11 hours after admission. At the end, 30 of the 125 patients (24%) were successfully managed without an operation (20 of 99 anterior and 10 of 26 posterior AGSW patients). There were no predictors of delayed laparotomy and no complications or mortality attributed to it. Ten patients (8%) had a nontherapeutic laparotomy, and 3 of them developed complications. Conclusions: Selective nonoperative management of AGSWis feasible and safe in trauma centers with low penetrating trauma volumes. Nearly 1 in 4 AGSW patients does not need a laparotomy, and nontherapeutic laparotomies are associated with complications. The volume of AGSW per se should not be an excuse for routine laparotomies. These data become particularly important because penetrating trauma volumes are decreasing around the country.

Original languageEnglish (US)
Pages (from-to)528-532
Number of pages5
JournalArchives of Surgery
Volume146
Issue number5
DOIs
StatePublished - May 2011
Externally publishedYes

ASJC Scopus subject areas

  • Surgery

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