Non-operative management of civilian abdominal gunshot wounds
Yıl: 2020 Cilt: 26 Sayı: 2 Sayfa Aralığı: 227 - 234 Metin Dili: İngilizce DOI: 10.14744/tjtes.2020.86132 İndeks Tarihi: 05-10-2020
Non-operative management of civilian abdominal gunshot wounds
Öz: ABSTRACTBACKGROUND: In this study, we aimed to evaluate the results of selective non-operative management in patients with civilian abdominal gunshot wounds.METHODS: Patients hospitalized and monitored in our clinic due to civilian abdominal gunshot wounds between January 2009 and January 2018 were retrospectively examined. Patients were studied concerning age, gender, mechanism of injury, anatomic injury site, Penetrating Abdominal Trauma Index (PATI), Injury Severity Score (ISS), Revised Trauma Score (RTS), treatment method, time to operation, days of hospitalization and mortality.RESULTS: Of the patients, 84 (89.4%) were male, and 10 (10.6%) were female with a mean age of 32.7 (range 4–60). The mean ISS, RTS and PATI values of all patients were 17.05, 7.27 and 9.21, respectively. Immediate laparotomy and/or thoracotomy were performed in 21 (22.3%) of the patients due to hemodynamic instability and in 27 (28.7%) of the patients because of peritonitis findings.The remaining 46 (48.9%) patients were managed non-operatively. Among these patients, early laparotomy was performed in five (5.3%) and late laparotomy in eight (8.5%) patients who developed peritonitis symptoms. The other 33 (35.1%) patients were treated non-operatively. Of these patients, 61.1% of the patients with flank injuries, 50% of the patients with right thoracoabdominal injuries, 44.4% of the patients with posterior abdominal injuries, 42.1% of the patients with pelvic injuries and 27.8% of the patients with left thoracoabdominal injuries were successfully treated non-operatively. Non-therapeutic or negative laparotomy was performed on six (6.4%) patients. Mortality was 10.6% (n=10) in all patients.CONCLUSION: Some patients with a civilian abdominal gunshot wound in certain anatomical localization who are hemodynamically stable and have no peritonitis symptoms can be non-operatively managed just as in patients with abdominal stab wounds. Success rates of selective non-operative management are high, especially in gunshot wounds of flank, posterior abdominal, thoracoabdominal and pelvic regions.
Anahtar Kelime: Sivil nedenli abdominal ateşli silah yaralanmalarında non-operatif tedavi
Öz: AMAÇ: Bu çalışmada sivil nedenli abdominal ateşli silah yaralanmalı (ASY) hastalarda selektif non-operatif tedavi (SNOT) sonuçlarını değerlendirmeyi amaçladık.GEREÇ VE YÖNTEM: Kliniğimizde Ocak 2009 ile Ocak 2018 tarihleri arasında sivil nedenli abdominal ASY nedeniyle yatırarak takip ve tedavi ettiğimiz hastalar ileriye yönelik veri tabanında geriye dönük olarak incelendi. Hastalar yaş, cinsiyet, yaralanma şekli, anatomik yaralanma bölgesi, Yaralanma Şiddet Skoru (ISS), Revize Edilmiş Travma Skoru (RTS), Penetran Abdominal Travma İndeksi (PATI), uygulanan tedavi yöntemi, ameliyata alınma süresi, hastanede yatış gün sayısı ve mortalite yönünden irdelendi.BULGULAR: Hastaların 84’ü (%89.4) erkek, 10’u (%10.6) kadın, ortalama yaş 32.7 (4–60 yaş) idi. Seksen iki hasta (%87.2) tabanca mermisi, 12 (%12.8) hasta tüfek saçması ile yaralanmıştı. Tüm hastaların ortalama ISS, RTS ve PATI değerleri sırasıyla 17.05, 7.27 ve 9.21 bulundu. Hastaların 21’ine (%22.3) hemodinamik instabilite, 27’sine (%28.7) ise peritonit bulguları nedeniyle hemen acil laparatomi ve/veya torakotomi uygulandı. Diğer 46 (%48.9) hasta kliniğe yatırılarak takip edildi. Bu hastalardan peritonit bulguları gelişen 5’ine (%5.3) erken laparatomi, 8’ine (%8.5) geç laparatomi uygulandı. Geriye kalan 33 (%35.1) hasta non-operatif olarak tedavi edildi. Flank yaralanmalarının %61.1’i, sağ torakoabdominal yaralanmaların %50’si, posteriyor abdominal yaralanmaların %44.4’ü, pelvik yaralanmaların %42.1’i ve sol torakoabdominal yaralanmaların %27.8’i başarılı şekilde SNOT uygulaması ile taburcu edildi. Sadece 6 (%6.4) hastaya gereksiz laparatomi uygulandı, toplam 10 (%10.6) hastada mortalite gelişti.TARTIŞMA: Hemodinamisi stabil olan ve peritonit bulgusu mevcut olmayan, belirli anatomik lokalizasyondaki sivil nedenli abdominal ASY’li hastaların bir kısmı, delici-kesici alet yaralanmalı hastalar gibi non-operatif tedavi edilebilir. Böylece gereksiz laparatomi ve buna bağlı komplikasyonlar azaltılabilir. Özellikle flank, posterior abdominal, torakoabdominal ve pelvik bölgenin ASY’de non-operatif takip ve tedavinin başarı oranlarının yüksek olduğu hatırda tutulmalıdır.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. Salim A, Velmahos GC. When to operate on abdominal gunshot wounds. Scand J Surg 2002;91:62–6.
- 2. Karateke F, Özyazıcı S, Daş K, Menekşe E, Önel S, Özdoğan M, et al. General approach to penetrating abdominal traumas of Turkish general surgeons: survey of practice. [Article in Turkish]. Ulus Travma Acil Cerrahi Derg 2013;19:463−8.
- 3. Jansen JO, Inaba K, Resnick S, Fraga GP, Starling SV, Rizoli SB, et al. Selective non-operative management of abdominal gunshot wounds: survey of practise. Injury 2013;44:639−44.
- 4. Jansen JO, Inaba K, Rizoli SB, Boffard KD, Demetriades D. Selective non-operative management of penetrating abdominal injury in Great Britain and Ireland: survey of practice. Injury 2012;43:1799–804.
- 5. Velmahos GC, Demetriades D, Toutouzas KG, Sarkisyan G, Chan LS, Ishak R, et al. Selective nonoperative management in 1,856 patients with abdominal gunshot wounds: should routine laparotomy still be the standard of care? Ann Surg 2001;234:395−402; discussion 402−3.
- 6. Renz BM, Feliciano DV. Unnecessary laparotomies for trauma: a prospective study of morbidity. J Trauma 1995;38:350–6.
- 7. Weigelt JA, Kingman RG. Complications of negative laparotomy for trauma. Am J Surg 1988;156:544–7.
- 8. Demetriades D, Vandenbossche P, Ritz M, Goodmann D, Kowalszik J. Non-therapeutic operations for penetrating trauma: early morbidity and mortality. Br J Surg 1993;80:860–1.
- 9. Butt MU, Zacharias N, Velmahos GC. Penetrating abdominal injuries: management controversies. Scand J Trauma Resusc Emerg Med 2009;17:19.
- 10. DuBose J, Inaba K, Teixeira PG, Pepe A, Dunham MB, McKenney M. Selective non-operative management of solid organ injury following abdominal gunshot wounds. Injury 2007;38:1084–90.
- 11. Moore EE, Moore JB, Van Duzer-Moore S, Thompson JS. Mandatory laparotomy for gunshot wounds penetrating the abdomen. Am J Surg 1980;140:847–51.
- 12. Laing GL, Skinner DL, Bruce JL, Bekker W, Oosthuizen GV, Clarke DL. A multi faceted quality improvement programme results in improved outcomes for the selective non-operative management of penetrating abdominal trauma in a developing world trauma centre. Injury 2014;45:327–32.
- 13. Demetriades D, Charalambides D, Lakhoo M, Pantanowitz D. Gunshot wound of the abdomen: role of selective conservative management. Br J Surg 1991;78:220–2.
- 14. Okuş A, Sevinç B, Ay S, Arslan K, Karahan Ö, Eryılmaz MA. Conservative management of abdominal injuries. Ulus Cerrahi Derg 2013;29:153–7.
- 15. Lichte P, Oberbeck R, Binnebösel M, Wildenauer R, Pape HC, Kobbe P. A civilian perspective on ballistic trauma and gunshot injuries. Scand J Trauma Resusc Emerg Med 2010;18:35.
- 16. Velmahos GC, Demetriades D, Cornwell EE 3rd. Transpelvic gunshot wounds: routine laparotomy or selective management?. World J Surg 1998;22:1034–8.
- 17. Starling SV, de Azevedo CI, Santana AV, Rodrigues Bde L, Drumond DA. Isolated liver gunshot injuries: nonoperative management is feasible?. Rev Col Bras Cir 2015;42:238–43.
- 18. Starling SV, Rodrigues Bde L, Martins MP, da Silva MS, Drumond DA. Non operative management of gunshot wounds on the right thoracoabdomen. Rev Col Bras Cir 2012;39:286–94.
- 19. Singh N, Hardcastle TC. Selective non operative management of gunshot wounds to the abdomen: a collective review. Int Emerg Nurs 2015;23:22–31.
- 20. Lamb CM, Garner JP. Selective non-operative management of civilian gunshot wounds to the abdomen: a systematic review of the evidence. Injury 2014;45:659–66.
- 21. Zafar SN, Rushing A, Haut ER, Kisat MT, Villegas CV, Chi A, et al. Outcome of selective non-operative management of penetrating abdominal injuries from the North American National Trauma Database. Br J Surg 2012;99:155−64.
- 22. Peev MP, Chang Y, King DR, Yeh DD, Kaafarani H, Fagenholz PJ, et al. Delayed laparotomy after selective non-operative management of penetrating abdominal injuries. World J Surg 2015;39:380−6.
- 23. Hope WW, Smith ST, Medieros B, Hughes KM, Kotwall CA, Clancy TV. Non-operative management in penetrating abdominal trauma: is it feasible at a Level II trauma center?. J Emerg Med 2012;43:190–5.
| APA | OZPEK A, Canbak T (2020). Non-operative management of civilian abdominal gunshot wounds. , 227 - 234. 10.14744/tjtes.2020.86132 |
| Chicago | OZPEK ADNAN,Canbak Tolga Non-operative management of civilian abdominal gunshot wounds. (2020): 227 - 234. 10.14744/tjtes.2020.86132 |
| MLA | OZPEK ADNAN,Canbak Tolga Non-operative management of civilian abdominal gunshot wounds. , 2020, ss.227 - 234. 10.14744/tjtes.2020.86132 |
| AMA | OZPEK A,Canbak T Non-operative management of civilian abdominal gunshot wounds. . 2020; 227 - 234. 10.14744/tjtes.2020.86132 |
| Vancouver | OZPEK A,Canbak T Non-operative management of civilian abdominal gunshot wounds. . 2020; 227 - 234. 10.14744/tjtes.2020.86132 |
| IEEE | OZPEK A,Canbak T "Non-operative management of civilian abdominal gunshot wounds." , ss.227 - 234, 2020. 10.14744/tjtes.2020.86132 |
| ISNAD | OZPEK, ADNAN - Canbak, Tolga. "Non-operative management of civilian abdominal gunshot wounds". (2020), 227-234. https://doi.org/10.14744/tjtes.2020.86132 |
| APA | OZPEK A, Canbak T (2020). Non-operative management of civilian abdominal gunshot wounds. Ulusal Travma ve Acil Cerrahi Dergisi, 26(2), 227 - 234. 10.14744/tjtes.2020.86132 |
| Chicago | OZPEK ADNAN,Canbak Tolga Non-operative management of civilian abdominal gunshot wounds. Ulusal Travma ve Acil Cerrahi Dergisi 26, no.2 (2020): 227 - 234. 10.14744/tjtes.2020.86132 |
| MLA | OZPEK ADNAN,Canbak Tolga Non-operative management of civilian abdominal gunshot wounds. Ulusal Travma ve Acil Cerrahi Dergisi, vol.26, no.2, 2020, ss.227 - 234. 10.14744/tjtes.2020.86132 |
| AMA | OZPEK A,Canbak T Non-operative management of civilian abdominal gunshot wounds. Ulusal Travma ve Acil Cerrahi Dergisi. 2020; 26(2): 227 - 234. 10.14744/tjtes.2020.86132 |
| Vancouver | OZPEK A,Canbak T Non-operative management of civilian abdominal gunshot wounds. Ulusal Travma ve Acil Cerrahi Dergisi. 2020; 26(2): 227 - 234. 10.14744/tjtes.2020.86132 |
| IEEE | OZPEK A,Canbak T "Non-operative management of civilian abdominal gunshot wounds." Ulusal Travma ve Acil Cerrahi Dergisi, 26, ss.227 - 234, 2020. 10.14744/tjtes.2020.86132 |
| ISNAD | OZPEK, ADNAN - Canbak, Tolga. "Non-operative management of civilian abdominal gunshot wounds". Ulusal Travma ve Acil Cerrahi Dergisi 26/2 (2020), 227-234. https://doi.org/10.14744/tjtes.2020.86132 |
