Conservative Management of Gunshot Wound to Anterior Abdomen in a Resource-Poor Setting in the Caribbean.

Kiran Chandolu,Anthony Maughn,Shariful Islam,Vijay Naraynsingh,Malini Ramnarine

doi:10.7759/cureus.16789

Abstract

Previously, the management of gunshot wounds (GSWs) to the anterior abdomen required exploratory laparotomy; however, this was associated with a considerable number of non-therapeutic surgeries. The use of non-operative management (NOM) of GSW to the abdomen is controversial, with many surgeons sceptical to accept this into their practice. The NOM of GSW to the abdomen employed in a selected group of patients has been shown to be safe and acceptable. Penetrating GSW to the thoraco-abdomen, back and lateral abdomen has been the most successful compared to the anterior penetrating wound. Most of the anterior GSWs to the abdomen are associated with viscus injury and require exploratory laparotomy. We report the case of a 58-year-old male who presented with a single GSW to the epigastrium with a contrast computed tomography scan demonstrating grade 3 liver lacerations, contusion to the right adrenal gland, with moderate free fluids in the retroperitoneum and the pelvis. The patient was haemodynamically stable and managed successfully with NOM. It is one of the safe routes of anterior penetration of GSW to the abdomen and treated with conservative management.

Highlights

Penetrating injury to the abdomen is the most common surgical admission
We report the case of a 58-year-old male who presented with a single gunshot wounds (GSWs) to the epigastrium with a contrast computed tomography scan demonstrating grade 3 liver lacerations, contusion to the right adrenal gland, with moderate free fluids in the retroperitoneum and the pelvis
The idea of selective non-operative management (SNOM) of penetrating injuries to the abdomen was first coined by Shaftan et al in 1969 [2]

Summary

Introduction

Penetrating injury to the abdomen is the most common surgical admission. Until today, the standard management of gunshot wounds (GSWs) to the abdominal cavity is mandatory laparotomy [1]. During 1990, serious concern was raised for mandatory laparotomy for all penetrating abdominal wounds Thereafter, it slowly gained acceptance amongst trauma surgeons all over the world. SNOM is often conducted in most trauma centres across the world in haemodynamically stable patients without any signs of peritonitis or evisceration This is only true for abdominal stab wounds [2,3,4] and not for the GSW into the abdomen. A 58-year-old male, known hypertensive presented with a single gunshot to the epigastrium for six hours (Figure 1) He experienced epigastric and right upper abdominal pain with no haemoptysis or per rectal bleeding. The bullet was seen within the soft tissue of the right flank at the level of the first lumbar vertebrae (Figure 6) This patient remained stable throughout the admission. At one year of follow-up, the patient was doing well with no further complaints

Discussion

Conclusions

Findings

Disclosures

Shaftan GW