Outcome of gunshot abdominal injuries

Acta Scientific Medical Sciences, 2022

Background: Abdominal gunshot wounds are common in areas of armed conflict. Mali a west African country has been going through a security crisis since 2012, which has led to an avalanche of wounds. The management of these wounds calls for multidisciplinary expertise due to their complexity. The aim of this work was to describe the clinical, epidemiological, surgical and therapeutic characteristics of abdominal gunshot wounds. Patients and Methods: This was a prospective study January 1, 2019 to December 31, 2019) on 1601 trauma received in emergency and general surgery departments of the Sominé DOLO Hospital of Mopti. The study involved all patients who had a gunshot wound to the abdomen during the study period. Data were entered into Excel and analyzed using SPSS (Statistical Package for Social Sciences) version 20 software. Results: A total of 27 cases (10.8%) of visceral gunshot wounds were recorded out of the 250 cases of ballistic wounds recorded during the study period. Intestinal perforation was the most common abdominal lesion, 11/27 cases (40.7%). The most surgical process performed was the ileo-ileal anastomosis resection with 9/27 cases (33.3%). The evolution was favorable in 22/27 (81.5%) of cases however was noted some cases of infectious complication and 2/27 cases of death (7.4%). Conclusion: Abdominal gunshot wounds are common in areas of armed conflict with intestinal perforation as the most common abdominal wound.

East African Medical Journal, 2006

Objective: To establish the pattern and results of interventions in patients with abdominal injuries requiring admission. Design: A descriptive, prospective, hospital-based study involving observation of patients from admission to final outcome of management as either discharged or deceased. Setting: Kenyatta National Hospital, a tertiary teaching and referral hospital in Nairobi, Kenya, from November 2004 to February 2005 in the adult general surgical wards. Patients: Eighty consecutive admissions of adult patients with either blunt or penetrating abdominal injuries.

Cureus, 2021

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 ...

Medicina

Abdominal injuries in children caused by guns are a rare clinical entity globally. But, in countries with undefined legal regulations and in war zones, urban violence is a tremendous social problem among older children and adolescents. This manuscript provides details regarding two cases of severe gunshot injuries in young children. The injuries were very complicated and included damage to the parenchymatous and hollow organs and major blood vessels. The clinical presentation on admission was severe and dramatic, but the patients survived. However, one patient developed numerous complications that required repeated surgical interventions and long treatment. This article provides a detailed description of injuries and how to treat them. Patient care requires a multidisciplinary approach, and the initial decision on further treatment depends on the patient’s hemodynamic stability.

Saudi medical journal, 2004

Traditionally, mandatory exploration was the rule for managing penetrating abdominal trauma, but this has begun to change in the recent era. The change first affected stab injuries, in which the conservative approach in appropriate cases has gained wide spread acceptance. Relatively recently, the management of gunshot injuries to the abdomen has been similarly affected, and several reports appeared describing the success of such treatment in selected cases.

Turkish journal of surgery, 2018

In line with advances in diagnostic methods and expectation of a decrease in the number of negative laparotomies, selective non-operative management of abdominal gunshot wounds has been increasingly used over the last three decades. We aim to detect the possibility of treatment without surgery and present our experience in selected cases referred from Syria to a hospital at the Turkish-Syrian border. Material and Methods: Between February 2012 and June 2014, patients admitted with abdominal gunshot wounds were analyzed. Computed tomography was performed for all patients on admission. Patients who were hemodynamically stable and did not have symptoms of peritonitis at the time of presentation were included in the study. The primary outcome parameters were mortality and morbidity. Successful selective non-operative management (Group 1) and unsuccessful selective non-operative management (Group 2) groups were compared in terms of complications, blood transfusion, injury site, injury severity score (ISS), and hospital stay. Results: Of 158 truncal injury patients, 18 were considered feasible for selective non-operative management. Of these, 14 (78%) patients were treated without surgery. Other Four patients were operated upon progressively increasing abdominal pain and tenderness during follow-up. On diagnostic exploration, all of these cases had intestinal perforations. No mortality was observed in selective non-operative management. There was no statistically significant difference between Group 1 and Group 2, in terms of length of hospital stay (96 and 127 h, respectively). Also, there was no difference between groups in terms of blood transfusion necessity, injury site, complication rate, and injury severity score (p>0.05). Conclusion: Decision making on patient selection for selective non-operative management is critical to ensure favorable outcomes. It is not possible to predict the success of selective non-operative management in advance. Cautious clinical examination and close monitoring of these patients is vital; however, emergency laparotomy should be performed in case of change in vital signs and positive symptoms concerning peritonitis.

International Journal of TROPICAL DISEASE & Health, 2021

Background: Gunshot injuries constitute significant contributor to morbidity and mortality of the healthcare in most societies. The global burden of gunshot injuries seems to be on the rise with the increase in violent crimes and unrest across the world. Aim: The aim of this study was to determine the pattern of gunshot injuries seen in the surgery departments of the two Teaching Hospitals in Port Harcourt from January 2010 to January 2019. Materials and Methods: A descriptive retrospective study was carried out using data obtained from registers for patients who had gunshot injuries from January 2010 to January 2019 in two government-owned tertiary healthcare facilities in Port Harcourt. Results: A total of 1138 cases of gunshot injuries was recorded within the ten-year study period, with relatively higher number of cases seen during the 2011/2012 (122/116), 2015 (134), and 2019 (138). The age range 20 - 44 years are more involved in these injuries, and abdominal injurie...

Journal of evolution of medical and dental sciences, 2013

A 30 year male patient presented in casualty with history of abdominal gunshot injury to left upper side of abdomen. Abdominal X Ray & CT Scan of abdomen revealed bullet at the level of L-5 vertebra. 1. On exploration there were (five) multiple perforations of jejunum & haemoperitoneum of 1.5 liters. The Bullet was impacted in the anterior aspect of body of L-5 vertebra with left common iliac vein puncture wound, which was extracted. 2. On admission patient was in hypotension, but responded well to resuscitation. 3. Patient didn't have any neurodeficit.

Annals of Surgery, 2001

To evaluate the safety of a policy of selective nonoperative management (SNOM) in patients with abdominal gunshot wounds.

ARS Medica Tomitana, 2023

Introduction: One of the causes of mortality in pediatric population is penetrating abdominal injuries, which can affect several organs. Among all types of abdominal trauma, in gunshot wounds a good prognostic requires prompt diagnosis and treatment. In Romania, there is no specific database on gunshot injuries in the pediatric population, but from various sources, it was found that there are 3 cases (1 case of abdominal injury caused by gunshot in rural area and 2 cases of head and cervical spine injury due to gunshot that took place in urban area). Case presentation: A 13-year-old boy is brought to the emergency care unit with a penetrating gunshot wound by ricochet in the left lower abdominal quadrant. Abdominal computed tomography revealed abdominal wall discontinuity in the left iliac fossa with oblique and posterior trajectory and a foreign body in the peritoneal cavity measuring 19/7 mm. Intraoperatory, the projectile was found in the sigmoid colon. Conclusion: Penetrating gunshot wounds in pediatric population need adequate investigation and prompt diagnosis despite hemodynamic stability at presentation. Successful management of such a patient depends on the accuracy of the surgical intervention as well as the existence of a multidisciplinary medical team, which helps to prevent significant complications, including death.