Assessment of the management and outcomes of penetrating abdominal shotgun injuries

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Background: Lately in Egypt, the incidence of abdominal shotgun injuries has greatly increased especially after the 25 th of January 2012 revolution. There is a controversy that exists over whether patients with penetrating abdominal shotgun wounds should have selective or mandatory exploration. This work aims to put a clear management plan for patients with penetrating abdominal shotgun injuries and to determine the role and indications of exploratory laparotomy to avoid unnecessary explorations and their complications. Methods: The study was conducted on 40 patients presented to Kasralainy medical school with penetrating abdominal shotgun injuries, who were randomly allocated into two groups, Group (1): the patients were treated conservatively for 72 hours and Group 2: the patients were explored. Results: In group (2), it was found that most of the patients (13 out of 18 which is 72.2%) had negative or non-significant injuries and only 5 out of 18 patients (27.8%) showed significant injuries which demanded repair. So, they were explored with no benefit but on the contrary they had the chance of developing complications of abdominal explorations and this truely occurred because the complications in group 2 were significantly higher than group (1) regarding postoperative wound infection and paralytic ileus. Also, incisional hernia and burst abdomen occurred in group 2. While in group (1), only 3 patients (13.6%) out of 22 had deteriorated during the follow up. which is a low percent especially that these patients could be detected early and managed. Conclusions: Conservative management for patients with intra-abdominal pellets who are vitally stable with no massive hemoperitonium or pneumoperitoniumon is feasible and safe with the ability of identification and management of patients who will require surgery by close follow up without increase in the major morbidities or mortalities. This strategy significantly reduces the rate of unnecessary laparotomies and related complications. Although the main drawback is the small number of the study group.