Selective conservative management of abdominal gunshot wounds: a prospective study

A prospective study of 111 patients with low velocity gunshot wounds of the abdomen was conducted to determine whether a policy of selective conservative management based on repeated physical examination is a safe form of treatment. Laparotomy was undertaken in 89 patients (80 per cent), seven of which were negative. Of the patients 22 (20 per cent), eight of whom were considered to have peritoneal penetration, underwent conservative management. None required delayed laparotomy. Eight patients (7 per cent) died, all deaths occurring in the positive laparotomy group. The incidence of significant intra-abdominal injury if the peritoneal cavity had been penetrated was 89 per cent. Selective conservative management may be applied safely to a limited group of patients with gunshot wounds of the abdomen.