Abdominal gunshot wounds: evaluating the role of computed tomography in surgical timing and decision-making

Abdominal gunshot wounds contribute significantly to trauma-related morbidity and mortality. Computed tomog-raphy (CT) can provide valuable diagnostic information but may potentially delay definitive treatment. This study aimed to evaluate the role of abdominal CT in surgical decision-making and timing among patients with abdominal gunshot injuries.

We retrospectively analyzed patients with abdominal gunshot wounds treated at a tertiary university hospital between January 2013 and January 2023. Collected data included demographic characteristics, physiological parameters, trauma scores, CT find-ings, time intervals (from admission to CT and to surgery), and clinical outcomes. Patients were classified as hemodynamically stable or unstable based on admission parameters and their response to resuscitation. The two groups were compared.

A total of 74 patients were included (94.5% male; median age, 32 years). Of these, 47 (63.5%) were hemodynamically stable at presentation, while 27 (36.5%) were unstable. Abdominal CT was performed in 67 patients (90.5%), with a median time of 28 minutes from admission. The median time to CT was similar between stable (28 minutes) and unstable (30 minutes) patients (p=0.934). Based on CT findings, nonoperative management was feasible in 10 patients (13.5%). Among the unstable group, CT was performed in 7 of 11 nonresponders, of whom six (54.5%) died. Among patients who underwent surgery, the mean time to operation was significantly shorter in unstable patients compared to stable patients (60.4±36.7 vs. 93.2±76.6 minut±es; p=0.034). The perioperative mortality rate was 9.3%, with all deaths occurring in hemodynamically unstable nonresponders.

Abdominal CT can aid surgical planning without causing significant delays in definitive treatment, even in initially unstable patients who respond to resuscitation. CT findings may support nonoperative management in selected cases and guide targeted surgical interventions in patients requiring operative treatment. However, these findings apply to carefully selected patients and should be interpreted cautiously, as this study does not establish the safety of CT in unselected hemodynamically unstable patients. The proximity of the CT scanner to the resuscitation area facilitated rapid imaging; therefore, the findings may not be generalizable to institutions with remotely located CT facilities.