Non-operative management of abdominal gunshot injuries: Is it safe in all cases?
Nidal İflazoğlu1
, Orhan Üreyen2, Osman Zekai Öner3, Ulvi Mehmet Meral4, Murat Yülüklü5
1Department of General Surgery, Kilis State Hospital, Kilis, Turkey
2Department of General Surgery, Bozyaka Training and Research Hospital, İzmir, Turkey
3Department of General Surgery, Antalya Training and Research Hospital, Antalya, Turkey
4Department of General Surgery, İzmir Military Hospital, İzmir, Turkey
5Department of General Surgery, Afyon State Hospital, Afyonkarahisar, Turkey
Abstract
Objective: In line with advances in diagnostic methods and expectation of a decrease in the number of negative laparotomies, selective non-operative management of abdominal gunshot wounds has been increasingly used over the last three decades. We aim to detect the possibility of treatment without surgery and present our experience in selected 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 wounds were analyzed. Computed tomography was performed for all patients on admission. Patients who were hemodynamically stable and did not have symptoms of peritonitis at the time of presentation were included in the study. The primary outcome parameters were mortality and morbidity. Successful selective non-operative management (Group 1) 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. Of these, 14 (78%) patients were treated without surgery. Other Four patients were operated upon progressively increasing abdominal pain and tenderness during follow-up. On diagnostic exploration, all of these cases had intestinal perforations. No mortality was observed in selective non-operative management. There was no statistically significant difference 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, and injury severity score (p>0.05).
Conclusion: Decision making on patient selection for selective non-operative management is critical to ensure favorable outcomes. It is not possible to predict the success of selective non-operative management in advance. Cautious clinical examination and close monitoring of these patients is vital; however, emergency laparotomy should be performed in case of change in vital signs and positive symptoms concerning peritonitis.
Keywords: Gunshot, non-operative management, selective, abdominal
This study was presented at the The 50th Congress of the European Society for Surgical Research, 10-13 June 2015, Liverpool, UK.
Cite this paper as: İflazoğlu N, Üreyen O, Öner OZ, Meral UM, Yülüklü M. Non-operative management of abdominal gunshot injuries: Is it safe in all cases? Turk J Surg 2018; 34: 38-42.
Authors declared that the research was conducted according to the principles of the World Medical Association Declaration of Helsinki “Ethical Principles for Medical Research Involving Human Subjects” (amended in October 2013).
Written informed consent was obtained from patients who participated in this study.
Externally peer-reviewed.
Concept - N.İ., O.Ü.; Design - N.İ., O.Ü., U.M.M.; Supervision - O.Ü., O.Z.Ö.; Resource - N.İ., O.Ü.; Materials - U.M.M., M.Y.; Data Collection and/or Processing - N.İ., U.M.M., M.Y.; Analysis and/or Interpretation - N.İ, O.Z.Ö, M.Y.; Literature Search - O.Ü., O.Z.Ö., U.M.M.; Writing Manuscript - N.İ., O.Ü.; Critical Reviews - O.Ü., U.M.M.
No conflict of interest was declared by the authors.
The authors declared that this study has received no financial support.