Conservative management versus surgical intervention for penetrating abdominal shotgun injuries

Abstract

Background: The objective of the study was to present our experience of selective conservative management of abdominal gunshot wounds in University hospital over three years.Methods: This prospective study included 30 patients who presented with shotgun injuries to the abdomen. The study included only patients with bird shots (small pellets, number 6), who are vitally stable with evidence of penetration on CT scan, and with no hemoperitoneum, pneumoperitoneum, or collection. They were allocated to one of two groups according to the surgeon preference. Patients in the Operative Group were transferred for immediate exploratory laparotomy. Patients in the Conservative Group were closely observed for 48 hours, received nothing per oral with the administration of antibiotics and fluid and no analgesics. After 48 hours, if the patients were stable with no complications, they were discharged. Conservative management was terminated for vital instability, hemoglobin drop, rising white blood cells count, fever, abdominal symptoms, and signs of peritonitis.Results: Exploration yielded a negative result in 9 out of 14 patients (64.3%) of the Operative Group. Four patients had significant injuries, and one had an insignificant injury. Postoperative complications occurred in 3 patients. Conservative management failed in one patient who developed high fever and abdominal symptoms.Conclusions:In patients with penetrating abdominal shotgun injuries with no evidence of abdominal organ injuries, conservative management is a safe and successful option based of strict selection criteria including small shots in a hemodynamically stable patient with evidence of penetration on CT scan, and with no hemoperitoneum, pneumoperitoneum or collection.