Nonoperative management of pelvic gunshot wounds

The nonoperative management (NOM) of abdominal gunshot injuries is gradually becoming the standard of care. Patients with pelvic gunshot injuries constitute a subgroup of patients at high risk of visceral injury. The aim of this study was to assess the feasibility and safety of the selective NOM of pelvic gunshot injuries.

This prospective study was performed from April 1, 2004, to November 30, 2008. Patients with pelvic gunshot injuries underwent laparotomy for peritonitis, hemodynamic instability, rectal bleeding, and urologic injuries. Patients with benign abdominal findings with hematuria underwent computed tomography scanning with intravenous contrast. Stable patients with no tenderness or minimal tenderness confined to the wound or wound tract underwent serial abdominal examination. Outcome parameters included need for delayed laparotomy, complications, length of hospital stay, and survival.

During the 54-month study period, 239 patients with pelvic gunshot injuries were treated. One hundred seventy-six (73.6%) patients underwent immediate laparotomy, whereas 63 (26.4%) were selected for NOM. The nontherapeutic laparotomy rate was 4.5% in the former group, and no patient required delayed laparotomy in the latter group. Also, 3 patients with minor extraperitoneal bladder injuries were successfully managed nonoperatively. Associated injuries included mostly fractures to the bony pelvis including the iliac blade (19), pubic ramii (3), and acetabulum (3). The mean hospital stay was 2.2 (range 1-8) days in the nonoperative group of patients. There were no deaths.

Selective NOM of pelvic gunshot injuries is a feasible, safe, and effective alternative to routine laparotomy.