Selective Non-Operative Management of Abdominal
Gunshot Wounds: A Predictor for Therapeutic Laparotomy
Supparerk Prichayudh MD*, Krerkrit Suksatian MD*, Suvit Sriussadaporn MD*, Rattaplee Pak-art MD*,
Sukanya Sriussadaporn MD*, Kritaya Kritayakirana MD*, Pasurachate Samorn MD*, Natawat Narueponjirakul MD*
Affiliation :
* Department of Surgery, Faculty of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok Thailand
Background : Selective non-operative management (SNOM) has been well accepted in abdominal gunshot wound (AGW)
patients. Since there is no uniform consensus regarding the criteria for SNOM, outcomes varied among institutions.
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
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