Selective conservative treatment for anterior abdominal gunshot: a literature narrative review

Abstract

<jats:p>ABSTRACT The nonoperative treatment of anterior abdominal gunshot wounds remains controversial. This article presents a narrative review of the literature after the selection of studies in electronic databases (PubMed, Cochrane Library and Lilacs), with the intention of evaluating the clinical and diagnostic tools that should be part of conservative selective approach of these lesions. It was observed that a nonoperative selective treatment can be effectively and safely used, when performed by a trained interdisciplinary team, working in adequate trauma centers. The selective nonoperative treatment is associated with a decrease in negative and nontherapeutic laparotomies, reducing the incidence of complications. It also contributes to the reduction of hospital costs.</jats:p>

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

“…The overall sample-size-weighted mean hospital length of stay among patients who underwent SNOM was six days versus 10 days if they failed SNOM or developed an in-hospital complication [ 8 ]. Similar results were also noted in a more recent systematic review by Silva [ 10 ]. Thus, a selected group of patients with GSW to the abdomen can be successfully managed by SNOM.…”

“…In patients with depressed conscious level, a severe injury requiring endotracheal intubation and sedation, in whom clinical examination will be unreliable, NOM is contraindicated. The sensitivity, specificity and accuracy of clinical examination in determining the need for urgent surgical intervention has been questioned [ 10 ]. Velmahos reported a sensitivity of 100% and specificity of 95.3% [ 10 ] for clinical examination and Demetriades found the sensitivity of 97.1% [ 11 ] supporting it as an accepted method for continued evaluation during NOM of GSW to the abdomen.…”

Tension-reduced closure of large abdominal wall defect caused by shotgun wound: A case report

“…Current treatment principles regarding shotgun wounds include initial debridement followed by wound closure to prevent damage to deep tissue. However, closure of the wound should be delayed until 15 d in patients with more severe contamination[ 9 ]. Further treatment is feasible after the patient’s vital signs have stabilized.…”