Selective conservatism in the management of penetrating abdominal bull-gore injuries

In a retrospective analysis it was found that not all patients with penetrating bull-gore injuries of the abdomen need exploration by formal laparotomy. A policy of selective conservatism was followed in the management of 18 out of 20 patients with bull-gore injuries of the abdomen in whom peritoneal breach was established either on presentation or by digital exploration of the wound. Formal laparotomy was reserved for specific clinical indications. Out of the 18 cases, 14 (78 per cent) were successfully treated non-operatively with wound excision, simple closure of the wound, and careful repeated clinical evaluation. There was no mortality in this group. Four cases (22 per cent) were explored; three of these had indications for exploration on presentation and the fourth was explored 4 days after admission. The latter was the only death that occurred in the series; the cause of death was probably pulmonary embolism. Omental and/or bowel evisceration occurred in 11 out of 18 cases (61 per cent). However, this was not considered an indication for exploration and all 11 cases were treated by simple replacement of omentum or bowel into the abdominal cavity. Penetrating abdominal bull-gore injuries can be managed safely by a policy of selective conservatism, reserving formal laparotomy for specific clinical indications.