RT Journal
A1 Fikry K, Velmahos GC, Bramos A, et al
T1 SUccessful selective nonoperative management of abdominal gunshot wounds despite low penetrating trauma volumes
JF Archives of Surgery
JO Archives of Surgery
YR 2011
FD May 1
VO 146
IS 5
SP 528
OP 532
DO 10.1001/archsurg.2011.94
UL http://dx.doi.org/10.1001/archsurg.2011.94
AB 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 AGSW is 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.