Selective Non-operative Management of Abdominal Gunshot Wounds with Associated Solid
Organ Injury
Liming Yu1, MD, John J. Como2 MD, MPH, Jeffrey Claridge3 MD
1
General Surgery Resident, Department of Surgery, University Hospitals, Case Medical Center, 11100
Euclid Avenue, Cleveland, OH 44106
2
Associate Trauma Director, MetroHealth Medical Center, Associate Professor of Surgery, CWRU
School of Medicine, Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of
Surgery, MetroHealth Medical Center, 2500 MetroHealth Drive,Cleveland, OH 44109
3
Trauma Director, MetroHealth Medical Center, Associate Professor of Surgery, CWRU School of
Medicine, Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery,
MetroHealth Medical Center, 2500 MetroHealth Drive,Cleveland, OH 44109
Background: A selective non-operative approach is commonly advocated for stable patients with
penetrating injuries to the abdomen who do not have peritonitis. We reported our experience with
selective non-operative management of patients with penetrating solid organ injuries after gunshot
wounds (GSW).
Results: Over a nine-year period from 2004 to 2012, 393 patients who sustained penetrating abdominal
injuries with solid organ injuries were treated at our institution. Of these, 292 sustained GSW. A total of
33 patients with abdominal GSW with solid organ injuries met criteria for selective non-operative
management and were treated without laparotomy. All underwent computed tomography (CT) of the
abdomen.
Eighteen of these patients suffered a solitary solid organ injury: 16 of these had liver injury and 2 had right
renal injury. Fifteen patients suffered more than one organ injury: 4 had liver/right lung/right diaphragm
injuries, 5 had liver/right kidney injuries, 1 had liver/right kidney/right adrenal injuries, 2 had liver/right
kidney/right diaphragm injuries, and 3 had liver/right diaphragm injuries.
The majority of these patients (25 patients) were managed in the surgical ICU. Only one patient required
angioembolization for active contrast extravasation, a patient who suffered combined liver and kidney
injuries with a large amount of active extravasation of intravenous noted from the liver parenchyma on CT
of the abdomen. The remaining 8 patients were monitored on the regular nursing floor. The mean hospital
stay was 15.5 days, ranging from 4 days to 35 days.
Conclusions: Our experience shows that selective non-operative management of penetrating abdominal
trauma with solid organ injury is safe and effective in a highly-select group of patients. It has been shown
to decrease the incidence of unnecessary laparotomy and length of hospital stay, and it therefore will lead
to decreased hospital costs.