Ulus Travma Acil Cerrahi Derg. 2020; 26(2): 227-234 | DOI: 10.14744/tjtes.2020.86132

Non-operative management of civilian abdominal gunshot wounds

Adnan Özpek, Tolga Canbak
Department of General Surgery, University of Health Sciences, Ümraniye Training and Research Hospital, Ýstanbul-Turkey

BACKGROUND: In this study, we aimed to evaluate the results of selective non-operative management in patients with civilian abdominal gunshot wounds.
METHODS: Patients hospitalized and monitored in our clinic due to civilian abdominal gunshot wounds between January 2009 and January 2018 were retrospectively examined. Patients were studied concerning age, gender, mechanism of injury, anatomic injury site, Penetrating Abdominal Trauma Index (PATI), Injury Severity Score (ISS), Revised Trauma Score (RTS), treatment method, time to operation, days of hospitalization and mortality.
RESULTS: Of the patients, 84 (89.4%) were male, and 10 (10.6%) were female with a mean age of 32.7 (range 4–60). The mean ISS, RTS and PATI values of all patients were 17.05, 7.27 and 9.21, respectively. Immediate laparotomy and/or thoracotomy were performed in 21 (22.3%) of the patients due to hemodynamic instability and in 27 (28.7%) of the patients because of peritonitis findings. The remaining 46 (48.9%) patients were managed non-operatively. Among these patients, early laparotomy was performed in five (5.3%) and late laparotomy in eight (8.5%) patients who developed peritonitis symptoms. The other 33 (35.1%) patients were treated non-operatively. Of these patients, 61.1% of the patients with flank injuries, 50% of the patients with right thoracoabdominal injuries, 44.4% of the patients with posterior abdominal injuries, 42.1% of the patients with pelvic injuries and 27.8% of the patients with left thoracoabdominal injuries were successfully treated non-operatively. Non-therapeutic or negative laparotomy was performed on six (6.4%) patients. Mortality was 10.6% (n=10) in all patients.
CONCLUSION: Some patients with a civilian abdominal gunshot wound in certain anatomical localization who are hemodynamically stable and have no peritonitis symptoms can be non-operatively managed just as in patients with abdominal stab wounds. Success rates of selective non-operative management are high, especially in gunshot wounds of flank, posterior abdominal, thoracoabdominal and pelvic regions.

Keywords: Abdominal trauma, civilian; gunshot wound; selective non-operative management.

---

Sivil nedenli abdominal ateþli silah yaralanmalarýnda non-operatif tedavi

Adnan Özpek, Tolga Canbak
Saðlýk Bilimleri Üniversitesi, Ümraniye Eðitim ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ýstanbul

AMAÇ: Bu çalýþmada sivil nedenli abdominal ateþli silah yaralanmalý (ASY) hastalarda selektif non-operatif tedavi (SNOT) sonuçlarýný deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Kliniðimizde Ocak 2009 ile Ocak 2018 tarihleri arasýnda sivil nedenli abdominal ASY nedeniyle yatýrarak takip ve tedavi ettiðimiz hastalar ileriye yönelik veri tabanýnda geriye dönük olarak incelendi. Hastalar yaþ, cinsiyet, yaralanma þekli, anatomik yaralanma bölgesi, Yaralanma Þiddet Skoru (ISS), Revize Edilmiþ Travma Skoru (RTS), Penetran Abdominal Travma Ýndeksi (PATI), uygulanan tedavi yöntemi, ameliyata alýnma süresi, hastanede yatýþ gün sayýsý ve mortalite yönünden irdelendi.
BULGULAR: Hastalarýn 84’ü (%89.4) erkek, 10’u (%10.6) kadýn, ortalama yaþ 32.7 (4–60 yaþ) idi. Seksen iki hasta (%87.2) tabanca mermisi, 12 (%12.8) hasta tüfek saçmasý ile yaralanmýþtý. Tüm hastalarýn ortalama ISS, RTS ve PATI deðerleri sýrasýyla 17.05, 7.27 ve 9.21 bulundu. Hastalarýn 21’ine (%22.3) hemodinamik instabilite, 27’sine (%28.7) ise peritonit bulgularý nedeniyle hemen acil laparatomi ve/veya torakotomi uygulandý. Diðer 46 (%48.9) hasta kliniðe yatýrýlarak takip edildi. Bu hastalardan peritonit bulgularý geliþen 5’ine (%5.3) erken laparatomi, 8’ine (%8.5) geç laparatomi uygulandý. Geriye kalan 33 (%35.1) hasta non-operatif olarak tedavi edildi. Flank yaralanmalarýnýn %61.1’i, sað torakoabdominal yaralanmalarýn %50’si, posteriyor abdominal yaralanmalarýn %44.4’ü, pelvik yaralanmalarýn %42.1’i ve sol torakoabdominal yaralanmalarýn %27.8’i baþarýlý þekilde SNOT uygulamasý ile taburcu edildi. Sadece 6 (%6.4) hastaya gereksiz laparatomi uygulandý, toplam 10 (%10.6) hastada mortalite geliþti.
TARTIÞMA: Hemodinamisi stabil olan ve peritonit bulgusu mevcut olmayan, belirli anatomik lokalizasyondaki sivil nedenli abdominal ASY’li hastalarýn bir kýsmý, delici-kesici alet yaralanmalý hastalar gibi non-operatif tedavi edilebilir. Böylece gereksiz laparatomi ve buna baðlý komplikasyonlar azaltýlabilir. Özellikle flank, posterior abdominal, torakoabdominal ve pelvik bölgenin ASY’de non-operatif takip ve tedavinin baþarý oranlarýnýn yüksek olduðu hatýrda tutulmalýdýr.

Anahtar Kelimeler: Abdominal travma, ateþli silah yaralanmasý; seçici non-operatif takip; sivil yaralanma.

---