Non-Operative Management of Thoracoabdominal Gunshot Injury: Thirteen Unusual Cases

Abstract

Background: Recently, the use of a surgical approach in injured patients has begun to be increasingly limited to unstable patients. Advances in imaging techniques and developments in intensive care have increased the applicability of non-operative treatment. Here, we aimed to present our clinical experience with different approaches in some patients.

Method: Thirteen inpatients who had thoracoabdominal gunshot injuries but did not undergo emergency surgery between 2009 and 2014 were retrospectively evaluated.

Results: Of the patients, nine (69.2%) were male and the mean age was 32.6 9.7 years. The mean trauma-treatment interval was 51.2 15.8 minutes. No surgical procedure was performed in 10 patients, four of whom had tangential injury. Diaphragmatic repair was performed in three patients after stabilization of solid organ injuries. The splenic and liver injuries were allowed to resolve itself through non-operative management, and there was no rush to repair the diaphragm until the splenic and liver recovery occurred. Four patients with tangential injury were shown not to have penetration of the abdominal cavity. Two pregnant patients, one with liver injury and the other with retroperitoneal injury, were successfully treated non-operatively.

Conclusions: In centers that provide advanced conditions for emergency surgery, a conservative approach can be performed successfully in selected thoracoabdominal gunshot wound patients, including pregnant patients and those with splenic injuries. Tangential injuries can be managed non-operatively after penetration of cavities is ruled out. When diaphragmatic hernia is accompanied by liver or splenic injury, diaphragmatic repair can be delayed until these injures are restricted themselves.




J Curr Surg. 2015;5(4):199-203
doi: http://dx.doi.org/10.14740/jcs281w