Surgery Not Always Recommended for Abdominal Gunshot Wounds

While severe gunshot injuries almost always require an operation to repair damaged organs, selective non-operative management (SNOM) is emerging as an alternative for less severe injuries that do not involve any major organ damage or significant blood loss. A recent study published in the Journal of the American College of Surgeons website highlights that in selected patients with abdominal gunshot injuries, avoiding an operation or non-operative management is acceptable and effective.

The report points out that selective non-operative management of abdominal gunshot wounds is safe and avoids unnecessary laparotomies, which are invasive open operations that may sometimes cause complications in the short and long abdominal muscles, creating adhesions, providing general anesthesia, and intubating the patients.

Medical records of 922 gunshot wound patients were evaluated, of which 707 (77 percent) had an immediate operation and 215 were managed with SNOM. The level of patient’s injuries was determined using a scoring system called the Injury Severity Score (ISS).

  • While patients who had SNOM had an average ISS of 8 (moderate to serious), those who underwent surgery had an ISS of 16 (severe)
  • SNOM patients had significantly lower rates of complications (8.5 percent vs. 34.7 percent for patients who underwent an operation), and
  • Death (0.5 percent vs. 5.2 percent)

The key factor in determining the need for an operation still remains a good clinical exam, including the assessment of abdominal pain. Also, adoption of SNOM is not universal. The lead author says, “There are academic and community hospitals with high trauma volumes that practice SNOM based on their experience and available resources. The concept becomes more challenging for smaller community hospitals that lack the experience and/or resources. Clinicians should practice what is best for their patients given the setting in which they work.”

Before surgical or medical intervention, it is critical for clinicians to observe and record gunshot injuries. Proper documentation of a gunshot wound includes the anatomic location, size, shape, and characteristics of the wound. Photography is also an easy and accurate way to document these wounds. Most clinics today use wound specific EMRs to ensure clear and fast documentation