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SELECTIVE NONOPERATIVE MANAGEMENT OF GUNSHOT WOUND TO THE ABDOMEN: THE ROLE OF COMPUTERIZED TOMOGRAPHY AND PATIENT CHARACTERISTICS
M Ethridge, R Hayward, E Edhayan
Ascension St. John Hospital and Medical Center

Background
Selective Nonoperative Management (SNOM) of Gunshot Wounds (GSW) to the abdomen is an emerging paradigm in the management of GSW to the abdomen. The goal of our study was to identify patient characteristics associated with successful nonoperative management of GSW to the abdomen. Computed Abdominal Tomography (CAT) scan results and surgical outcomes were studied.

Methods
A retrospective review of the Trauma registry was conducted from January 1 2018, to December 31, 2020. Patients that underwent a CAT scan of the abdomen for a GSW of the abdomen during initial resuscitation were included. Presenting vital signs, body mass index (BMI), CAT scan findings and patient discharge information were studied.

Results
A total of 63 patients underwent a CAT scan during the initial resuscitation period. 43 patients were managed non-operatively including six who had an isolated GSW to the liver. There were no deaths and all were discharged home. 20 patients underwent either diagnostic laparoscopy or laparotomy. Five of these patients had a non penetrating abdominal GSW. There were two deaths. Stable vital signs and CAT scan findings were predictors of successful SNOM of GSW to the abdomen.

Conclusion
SNOM of GSW to the abdomen is safe in patients that have stable vital signs and a CAT scan that delineates injury patterns. Use of CAT scans for SNOM of GSW to the abdomen should be part of the trauma surgeons armamentarium.


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