A new tailored protocol based on laparoscopy in the management of abdominal shotgun injuries: a case-series study
Purpose Abdominal shotgun injuries derive their significance from the wide range of injuries they cause. The management of this type of injury has been continuously evolving. Despite the ongoing incorporation of laparoscopy in management of abdominal trauma, there is no definite protocol raising the...
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| Veröffentlicht in: | European journal of trauma and emergency surgery (Munich : 2007) 2020-06, Vol.46 (3), p.607-613 |
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| container_title | European journal of trauma and emergency surgery (Munich : 2007) |
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| creator | Mansour, Doaa Ahmed Elshaer, Ahmed Mohammed Elshazly, Mostafa Abd-Rahman |
| description | Purpose
Abdominal shotgun injuries derive their significance from the wide range of injuries they cause. The management of this type of injury has been continuously evolving. Despite the ongoing incorporation of laparoscopy in management of abdominal trauma, there is no definite protocol raising the role of laparoscopy in such injuries. In this study, we outlined a tailored protocol in the management of penetrating abdominal shotgun injuries differing from the previous protocols which comprised either mandatory exploration or non-operative management.
Patients and methods
This case-series study included patients who attended to our emergency department with a shotgun injury involving the abdomen between December 2014 and October 2016. Only stable patients with no clinical signs of surgical abdomen, in combination with CT evidence of penetrating intra-abdominal pellets, were subjected to laparoscopic exploration in this study.
Results
Thirty patients fulfilled the inclusion criteria. During laparoscopy, ten patients were designated as positive for injuries. No missed injuries were identified. Two of the cases identified as positive by laparoscopy needed no further management while the remaining eight patients warranted laparotomy. Only one of these eight patients turned out to have a non-therapeutic exploration. Consequently, laparoscopy in the management of these injuries had an overall accuracy of 96.7%, sensitivity of 100%, specificity of 95.7%, positive predictive value of 87.5% and negative predictive value of 100% with highly significant
p
value |
| doi_str_mv | 10.1007/s00068-018-1015-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2112189944</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2112189944</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-498470bc5db37cde12dc0ee8e2a4ba221de237d6df1d01262f263c9b55eaab9a3</originalsourceid><addsrcrecordid>eNp1kU1rGzEQhkVoqPPRH5BLEfTSyyYaaT97M6FJC4FckrOYlWadNbuSLe1S_O8jx4kLhZ6kQc-8YuZh7ArENQhR3UQhRFlnAuoMBBRZdcLOoC5V1jQ5fDrelVqw8xjXCRZlIT-zhRKyACjkGdsuuaM_fMJ-8IEs3wQ_eeMH3mJMpXd8wA0GH43f7Hjv-PRCfESHKxrJTdx3HFvrx97hwOOLn1azS9h6Dj3FHxy5STlZpH3J4zTb3SU77XCI9OX9vGDPdz-fbn9lD4_3v2-XD5lRlZyyvKnzSrSmsK2qjCWQ1giimiTmLUoJlqSqbGk7sAJkKTtZKtO0RUGIbYPqgn0_5KaRtjPFSY99NDQM6MjPUUsACXXaVJ7Qb_-gaz-HNNEbBaoWeVUnCg6USeuIgTq9Cf2IYadB6L0PffChkw-996Gr1PP1PXluR7LHjg8BCZAHIKYnt6Lw9-v_p74CQc2WjQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2111380478</pqid></control><display><type>article</type><title>A new tailored protocol based on laparoscopy in the management of abdominal shotgun injuries: a case-series study</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Mansour, Doaa Ahmed ; Elshaer, Ahmed Mohammed ; Elshazly, Mostafa Abd-Rahman</creator><creatorcontrib>Mansour, Doaa Ahmed ; Elshaer, Ahmed Mohammed ; Elshazly, Mostafa Abd-Rahman</creatorcontrib><description>Purpose
Abdominal shotgun injuries derive their significance from the wide range of injuries they cause. The management of this type of injury has been continuously evolving. Despite the ongoing incorporation of laparoscopy in management of abdominal trauma, there is no definite protocol raising the role of laparoscopy in such injuries. In this study, we outlined a tailored protocol in the management of penetrating abdominal shotgun injuries differing from the previous protocols which comprised either mandatory exploration or non-operative management.
Patients and methods
This case-series study included patients who attended to our emergency department with a shotgun injury involving the abdomen between December 2014 and October 2016. Only stable patients with no clinical signs of surgical abdomen, in combination with CT evidence of penetrating intra-abdominal pellets, were subjected to laparoscopic exploration in this study.
Results
Thirty patients fulfilled the inclusion criteria. During laparoscopy, ten patients were designated as positive for injuries. No missed injuries were identified. Two of the cases identified as positive by laparoscopy needed no further management while the remaining eight patients warranted laparotomy. Only one of these eight patients turned out to have a non-therapeutic exploration. Consequently, laparoscopy in the management of these injuries had an overall accuracy of 96.7%, sensitivity of 100%, specificity of 95.7%, positive predictive value of 87.5% and negative predictive value of 100% with highly significant
p
value < 0.001.
Conclusion
A tailored protocol relying on the use of laparoscopy in the management of stable patients with CT evidence of penetrating abdominal shotgun injuries is safe and helps to cut down the number of non-therapeutic laparotomies with consequent decrease of complications.</description><identifier>ISSN: 1863-9933</identifier><identifier>EISSN: 1863-9941</identifier><identifier>DOI: 10.1007/s00068-018-1015-7</identifier><identifier>PMID: 30251152</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Abdomen ; Abdominal Injuries - diagnostic imaging ; Abdominal Injuries - surgery ; Adolescent ; Adult ; Child ; Critical Care Medicine ; Emergency Medicine ; Female ; Foreign Bodies - diagnostic imaging ; Foreign Bodies - surgery ; Humans ; Injuries ; Intensive ; Laparoscopy ; Laparoscopy - methods ; Male ; Medicine ; Medicine & Public Health ; Original Article ; Prospective Studies ; Sports Medicine ; Surgery ; Surgical Orthopedics ; Tomography, X-Ray Computed ; Traumatic Surgery ; Wounds, Gunshot - diagnostic imaging ; Wounds, Gunshot - surgery</subject><ispartof>European journal of trauma and emergency surgery (Munich : 2007), 2020-06, Vol.46 (3), p.607-613</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2018</rights><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2018.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-498470bc5db37cde12dc0ee8e2a4ba221de237d6df1d01262f263c9b55eaab9a3</citedby><cites>FETCH-LOGICAL-c372t-498470bc5db37cde12dc0ee8e2a4ba221de237d6df1d01262f263c9b55eaab9a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00068-018-1015-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00068-018-1015-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51298</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30251152$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mansour, Doaa Ahmed</creatorcontrib><creatorcontrib>Elshaer, Ahmed Mohammed</creatorcontrib><creatorcontrib>Elshazly, Mostafa Abd-Rahman</creatorcontrib><title>A new tailored protocol based on laparoscopy in the management of abdominal shotgun injuries: a case-series study</title><title>European journal of trauma and emergency surgery (Munich : 2007)</title><addtitle>Eur J Trauma Emerg Surg</addtitle><addtitle>Eur J Trauma Emerg Surg</addtitle><description>Purpose
Abdominal shotgun injuries derive their significance from the wide range of injuries they cause. The management of this type of injury has been continuously evolving. Despite the ongoing incorporation of laparoscopy in management of abdominal trauma, there is no definite protocol raising the role of laparoscopy in such injuries. In this study, we outlined a tailored protocol in the management of penetrating abdominal shotgun injuries differing from the previous protocols which comprised either mandatory exploration or non-operative management.
Patients and methods
This case-series study included patients who attended to our emergency department with a shotgun injury involving the abdomen between December 2014 and October 2016. Only stable patients with no clinical signs of surgical abdomen, in combination with CT evidence of penetrating intra-abdominal pellets, were subjected to laparoscopic exploration in this study.
Results
Thirty patients fulfilled the inclusion criteria. During laparoscopy, ten patients were designated as positive for injuries. No missed injuries were identified. Two of the cases identified as positive by laparoscopy needed no further management while the remaining eight patients warranted laparotomy. Only one of these eight patients turned out to have a non-therapeutic exploration. Consequently, laparoscopy in the management of these injuries had an overall accuracy of 96.7%, sensitivity of 100%, specificity of 95.7%, positive predictive value of 87.5% and negative predictive value of 100% with highly significant
p
value < 0.001.
Conclusion
A tailored protocol relying on the use of laparoscopy in the management of stable patients with CT evidence of penetrating abdominal shotgun injuries is safe and helps to cut down the number of non-therapeutic laparotomies with consequent decrease of complications.</description><subject>Abdomen</subject><subject>Abdominal Injuries - diagnostic imaging</subject><subject>Abdominal Injuries - surgery</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Child</subject><subject>Critical Care Medicine</subject><subject>Emergency Medicine</subject><subject>Female</subject><subject>Foreign Bodies - diagnostic imaging</subject><subject>Foreign Bodies - surgery</subject><subject>Humans</subject><subject>Injuries</subject><subject>Intensive</subject><subject>Laparoscopy</subject><subject>Laparoscopy - methods</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Prospective Studies</subject><subject>Sports Medicine</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Tomography, X-Ray Computed</subject><subject>Traumatic Surgery</subject><subject>Wounds, Gunshot - diagnostic imaging</subject><subject>Wounds, Gunshot - surgery</subject><issn>1863-9933</issn><issn>1863-9941</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kU1rGzEQhkVoqPPRH5BLEfTSyyYaaT97M6FJC4FckrOYlWadNbuSLe1S_O8jx4kLhZ6kQc-8YuZh7ArENQhR3UQhRFlnAuoMBBRZdcLOoC5V1jQ5fDrelVqw8xjXCRZlIT-zhRKyACjkGdsuuaM_fMJ-8IEs3wQ_eeMH3mJMpXd8wA0GH43f7Hjv-PRCfESHKxrJTdx3HFvrx97hwOOLn1azS9h6Dj3FHxy5STlZpH3J4zTb3SU77XCI9OX9vGDPdz-fbn9lD4_3v2-XD5lRlZyyvKnzSrSmsK2qjCWQ1giimiTmLUoJlqSqbGk7sAJkKTtZKtO0RUGIbYPqgn0_5KaRtjPFSY99NDQM6MjPUUsACXXaVJ7Qb_-gaz-HNNEbBaoWeVUnCg6USeuIgTq9Cf2IYadB6L0PffChkw-996Gr1PP1PXluR7LHjg8BCZAHIKYnt6Lw9-v_p74CQc2WjQ</recordid><startdate>20200601</startdate><enddate>20200601</enddate><creator>Mansour, Doaa Ahmed</creator><creator>Elshaer, Ahmed Mohammed</creator><creator>Elshazly, Mostafa Abd-Rahman</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20200601</creationdate><title>A new tailored protocol based on laparoscopy in the management of abdominal shotgun injuries: a case-series study</title><author>Mansour, Doaa Ahmed ; Elshaer, Ahmed Mohammed ; Elshazly, Mostafa Abd-Rahman</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-498470bc5db37cde12dc0ee8e2a4ba221de237d6df1d01262f263c9b55eaab9a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Abdomen</topic><topic>Abdominal Injuries - diagnostic imaging</topic><topic>Abdominal Injuries - surgery</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Child</topic><topic>Critical Care Medicine</topic><topic>Emergency Medicine</topic><topic>Female</topic><topic>Foreign Bodies - diagnostic imaging</topic><topic>Foreign Bodies - surgery</topic><topic>Humans</topic><topic>Injuries</topic><topic>Intensive</topic><topic>Laparoscopy</topic><topic>Laparoscopy - methods</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Prospective Studies</topic><topic>Sports Medicine</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Tomography, X-Ray Computed</topic><topic>Traumatic Surgery</topic><topic>Wounds, Gunshot - diagnostic imaging</topic><topic>Wounds, Gunshot - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mansour, Doaa Ahmed</creatorcontrib><creatorcontrib>Elshaer, Ahmed Mohammed</creatorcontrib><creatorcontrib>Elshazly, Mostafa Abd-Rahman</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mansour, Doaa Ahmed</au><au>Elshaer, Ahmed Mohammed</au><au>Elshazly, Mostafa Abd-Rahman</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A new tailored protocol based on laparoscopy in the management of abdominal shotgun injuries: a case-series study</atitle><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle><stitle>Eur J Trauma Emerg Surg</stitle><addtitle>Eur J Trauma Emerg Surg</addtitle><date>2020-06-01</date><risdate>2020</risdate><volume>46</volume><issue>3</issue><spage>607</spage><epage>613</epage><pages>607-613</pages><issn>1863-9933</issn><eissn>1863-9941</eissn><abstract>Purpose
Abdominal shotgun injuries derive their significance from the wide range of injuries they cause. The management of this type of injury has been continuously evolving. Despite the ongoing incorporation of laparoscopy in management of abdominal trauma, there is no definite protocol raising the role of laparoscopy in such injuries. In this study, we outlined a tailored protocol in the management of penetrating abdominal shotgun injuries differing from the previous protocols which comprised either mandatory exploration or non-operative management.
Patients and methods
This case-series study included patients who attended to our emergency department with a shotgun injury involving the abdomen between December 2014 and October 2016. Only stable patients with no clinical signs of surgical abdomen, in combination with CT evidence of penetrating intra-abdominal pellets, were subjected to laparoscopic exploration in this study.
Results
Thirty patients fulfilled the inclusion criteria. During laparoscopy, ten patients were designated as positive for injuries. No missed injuries were identified. Two of the cases identified as positive by laparoscopy needed no further management while the remaining eight patients warranted laparotomy. Only one of these eight patients turned out to have a non-therapeutic exploration. Consequently, laparoscopy in the management of these injuries had an overall accuracy of 96.7%, sensitivity of 100%, specificity of 95.7%, positive predictive value of 87.5% and negative predictive value of 100% with highly significant
p
value < 0.001.
Conclusion
A tailored protocol relying on the use of laparoscopy in the management of stable patients with CT evidence of penetrating abdominal shotgun injuries is safe and helps to cut down the number of non-therapeutic laparotomies with consequent decrease of complications.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30251152</pmid><doi>10.1007/s00068-018-1015-7</doi><tpages>7</tpages></addata></record> |
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| issn | 1863-9933 1863-9941 |
| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Abdomen Abdominal Injuries - diagnostic imaging Abdominal Injuries - surgery Adolescent Adult Child Critical Care Medicine Emergency Medicine Female Foreign Bodies - diagnostic imaging Foreign Bodies - surgery Humans Injuries Intensive Laparoscopy Laparoscopy - methods Male Medicine Medicine & Public Health Original Article Prospective Studies Sports Medicine Surgery Surgical Orthopedics Tomography, X-Ray Computed Traumatic Surgery Wounds, Gunshot - diagnostic imaging Wounds, Gunshot - surgery |
| title | A new tailored protocol based on laparoscopy in the management of abdominal shotgun injuries: a case-series study |
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