When to operate and abdominal gunshot wounds

ABSTRACT

Violence has become part and parcel of the daily routine of living, the prospective study of 86 patients, sustaining abdominal gunshot wounds was designed to evaluate the pattern, presentation and treatment outcome. Descriptive study. This study was conducted at the department of Surgery, Ghulam Muhammad Mahar Medical College Sukkur from January 2011 to January 2012. patients presenting with abdominal firearm wounds at accident and emergency department were included in this study, clinically all were evaluated, resuscitated and their findings were recorded on proforma. Patients with signs of acute abdomen [peritonitis]/ shock underwent midline emergency laparotomy, others having minimal or equivocal abdominal signs were selected for observation [non-operative management] group. Total number of patients included was 86, all were males, they belonged to age varying from 15-70 years. 54 [62.8%] were below the 40 years of age, in 44 [51.1%] cases instrument of attack used by assailant was pistol/shotgun, 45[52.3%] cases were victims of armed robbery, in 75 [87.2%] entrance wounds were present in anterior abdominal wall where as in 11[12.1%] were present posterirly, 67 [77.9%] underwent emergency laparotomy and 19 [22%] were observed initially. Two patients belonging to observation group showed failure, needed delayed laparotomy and both had positive laparotomy. Gunshot wounds of abdomen can be safely managed non-operatively, in the absence of abdominal tenderness haemodynamic instability or inevaluable factors as head injury and heavy intoxication. Success of non operative management depends upon continuous monitoring and frequent clinical examination