Abdominal Gunshot Wounds… Wait or operate?

An interesting study out of Massachusetts General Hospital in the current Archives of Surgery titled, “Successful Selective Nonoperative Management of Abdominal Gunshot Wounds Despite Low Penetrating Trauma Volumes”, highlights ten years of data for patients with abdominal gunshot wounds (AGSWs).

The study concludes that a nonoperative – wait and see approach – is “feasible and safe in trauma centers with low penetrating trauma volumes”. The sample size for the study was approximately 125 patients over ten years. Of those 125 patients, 30 percent were managed safely without a surgical procedure. The study concludes that, “nearly 1 in 4 abdominal gunshot wound patients does not need a laparotomy, and nontherapeutic laparotomies are associated with complications.”

The majority of patients seen at trauma centers are treated for blunt non-penetrating injuries, and Boston Medical Center is no different. For those patients with penetrating injuries such as abdominal gunshot wounds, we agree that a nonoperative approach described in the study can be appropriate. 

In the years 2008 -10 we saw approximately 50 abdominal gunshot wounds per year. When we excluded tangential injuries and deaths in the emergency department, analysis of our data reveals that we managed over 50% operatively and successfully treated approximately 4 in 10 (42.8%) expectantly, without operation. 

While we agree with the authors, we think it is important to remember that a majority of patients with 
abdominal gunshot wounds will require surgical intervention. If nonoperative management is to be considered, the ideal setting is a trauma center with the collective experience of a dedicated trauma team and protocols assuring around-the-clock monitoring. To do otherwise incurs unnecessary risk. 


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