Selective non–operative treatment of gunshot penetrating abdominal wounds

Abstract

Objective. To analyse own experience and determine the feasibility and tactics of selective non–operative treatment of gunshot penetrating abdominal wounds. Materials and methods. The study involved 74 servicemen (all men) with gunshot shrapnel penetrating abdominal wounds, who were divided into two groups: the main group – 26 (35.2% ± 0.2%) wounded who received non–surgical treatment, and the control group – 48 (64.8% ± 0.3%) wounded who received surgical treatment in the form of diagnostic laparotomy or laparoscopy. Non–surgical treatment included pain relief, antibiotic prophylaxis, tetanus toxoid administration and dressings. Results. In general, selective nonoperative treatment of gunshot penetrating abdominal wounds was used in 1% of the wounded. Isolated abdominal wounds were present in 32 (43.2% ± 0.2%) and thoracoabdominal wounds in 42 (56.8% ± 0.3%) patients. In terms of the number of foreign bodies, wounds were single in 66 (89.2% ± 0.3%) and multiple (liver and retroperitoneal space) in 8 (10.8% ± 0.1%) patients. In the main group, there were no surgical interventions or complications, in the control group, 8 (16.7% ± 0.1%) diagnostic laparotomies and 40 (83.3% ± 0.3%) diagnostic laparoscopies were performed, and there were 2 (4.2% ± 0.1%) complications – seroma and pneumonia. The average treatment period was (5 ± 0.3) days in the main group and (8 ± 0.4) days in the control group. Conclusions. Selective non–surgical treatment of gunshot penetrating abdominal wounds is indicated in haemodynamically stable patients without reduced level of consciousness and signs of peritonitis and intra–abdominal bleeding, abdominal pain syndrome with a follow–up period of 24 – 48 hours. The tactic of selective non–operative treatment of gunshot penetrating abdominal wounds is advisable mainly in case of damage to parenchymal organs. This tactic can be used in the presence of expert–class equipment, experienced specialists in the conditions of the third level of medical care and interaction between the second and third levels of medical care.