Objective: To examine the outcomes of SNOM in AGW patients at our institution and to identify the predictor for therapeutic laparotomy.

Material and Method: A retrospective study was performed on AGW patients between January 2004 and December 2014. Laparotomy was done in patients with 1) shock and/or peritonitis, 2) gastrointestinal (GI) bleeding, and 3) suspected peritoneal penetration (PP), with an exception of isolated right upper quadrant/right thoracoabdominal (RUQ/RTA) gunshot wound. SNOM was attempted in 1) patients with no PP (tangential AGW), and 2) stable patients with RUQ/RTA gunshot wound. Outcomes in terms of mortality and non-therapeutic laparotomy rate were analyzed. Stepwise logistic regression of the emergency department parameters was performed to identify predictors for therapeutic laparotomy.

Results: Eighty AGW patients were included in the present study. Forty-seven patients underwent immediate operation (32 shock/peritonitis, one rectal bleeding, and 14 PP), 46 had a therapeutic laparotomy. SNOM was attempted in 28 tangential AGW patients (all successful), four stable RUQ/RTA gunshot wound patients (one failure due to continued bleeding), and one patient with delayed presentation (successful). Overall, a successful SNOM was carried out in 32 patients (40%), the non-therapeutic laparotomy rate was 2%, and the mortality rate was 8%. The only predictor for therapeutic laparotomy identified in the present study was a positive focused assessment with sonography for trauma (FAST) result (odds ratio 51.2, 95% CI 6.3 to 414.9, p<0.001).

Conclusion: SNOM can be performed safely in patients with tangential AGW and stable isolated RUQ/RTA gunshot wound patients. FAST may be helpful in predicting a therapeutic laparotomy in AGW patients.

Keywords: Abdominal gunshot wounds, Selective non-operative management, Predictor for therapeutic laparotomy, FAST