Nonoperative management of pelvic gunshot wounds
Abstract Background The nonoperative management (NOM) of abdominal gunshot injuries is gradually becoming the standard of care. Patients with pelvic gunshot injuries constitute a subgroup of patients at high risk of visceral injury. The aim of this study was to assess the feasibility and safety of t...
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| Veröffentlicht in: | The American journal of surgery 2011-06, Vol.201 (6), p.784-788 |
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| container_title | The American journal of surgery |
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| description | Abstract Background The nonoperative management (NOM) of abdominal gunshot injuries is gradually becoming the standard of care. Patients with pelvic gunshot injuries constitute a subgroup of patients at high risk of visceral injury. The aim of this study was to assess the feasibility and safety of the selective NOM of pelvic gunshot injuries. Patients and methods This prospective study was performed from April 1, 2004, to November 30, 2008. Patients with pelvic gunshot injuries underwent laparotomy for peritonitis, hemodynamic instability, rectal bleeding, and urologic injuries. Patients with benign abdominal findings with hematuria underwent computed tomography scanning with intravenous contrast. Stable patients with no tenderness or minimal tenderness confined to the wound or wound tract underwent serial abdominal examination. Outcome parameters included need for delayed laparotomy, complications, length of hospital stay, and survival. Results During the 54-month study period, 239 patients with pelvic gunshot injuries were treated. One hundred seventy-six (73.6%) patients underwent immediate laparotomy, whereas 63 (26.4%) were selected for NOM. The nontherapeutic laparotomy rate was 4.5% in the former group, and no patient required delayed laparotomy in the latter group. Also, 3 patients with minor extraperitoneal bladder injuries were successfully managed nonoperatively. Associated injuries included mostly fractures to the bony pelvis including the iliac blade (19), pubic ramii (3), and acetabulum (3). The mean hospital stay was 2.2 (range 1–8) days in the nonoperative group of patients. There were no deaths. Conclusions Selective NOM of pelvic gunshot injuries is a feasible, safe, and effective alternative to routine laparotomy. |
| doi_str_mv | 10.1016/j.amjsurg.2010.03.014 |
| format | Article |
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(Surg.) ; Edu, Sorin, F.C.S.(S.A.) ; Nicol, Andrew J., F.C.S.(S.A.)</creator><creatorcontrib>Navsaria, Pradeep H., F.C.S.(S.A.), M.Med. (Surg.) ; Edu, Sorin, F.C.S.(S.A.) ; Nicol, Andrew J., F.C.S.(S.A.)</creatorcontrib><description>Abstract Background The nonoperative management (NOM) of abdominal gunshot injuries is gradually becoming the standard of care. Patients with pelvic gunshot injuries constitute a subgroup of patients at high risk of visceral injury. The aim of this study was to assess the feasibility and safety of the selective NOM of pelvic gunshot injuries. Patients and methods This prospective study was performed from April 1, 2004, to November 30, 2008. Patients with pelvic gunshot injuries underwent laparotomy for peritonitis, hemodynamic instability, rectal bleeding, and urologic injuries. Patients with benign abdominal findings with hematuria underwent computed tomography scanning with intravenous contrast. Stable patients with no tenderness or minimal tenderness confined to the wound or wound tract underwent serial abdominal examination. Outcome parameters included need for delayed laparotomy, complications, length of hospital stay, and survival. Results During the 54-month study period, 239 patients with pelvic gunshot injuries were treated. One hundred seventy-six (73.6%) patients underwent immediate laparotomy, whereas 63 (26.4%) were selected for NOM. The nontherapeutic laparotomy rate was 4.5% in the former group, and no patient required delayed laparotomy in the latter group. Also, 3 patients with minor extraperitoneal bladder injuries were successfully managed nonoperatively. Associated injuries included mostly fractures to the bony pelvis including the iliac blade (19), pubic ramii (3), and acetabulum (3). The mean hospital stay was 2.2 (range 1–8) days in the nonoperative group of patients. There were no deaths. Conclusions Selective NOM of pelvic gunshot injuries is a feasible, safe, and effective alternative to routine laparotomy.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2010.03.014</identifier><identifier>PMID: 20883972</identifier><identifier>CODEN: AJSUAB</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Abdomen ; Abdominal gunshot wounds ; Acetabulum ; Adolescent ; Adult ; Antibiotics ; Benign ; Biological and medical sciences ; Bladder ; Bleeding ; Complications ; Computed tomography ; Drainage - methods ; Fatalities ; Feasibility studies ; Female ; Follow-Up Studies ; Fractures ; General aspects ; Health risks ; Hematuria ; Humans ; Ilium - injuries ; Injuries ; Intravenous administration ; Length of Stay ; Male ; Medical imaging ; Medical sciences ; Middle Aged ; Multiple Trauma - diagnosis ; Multiple Trauma - therapy ; Nonoperative management ; Patients ; Pelvic gunshot wounds ; Pelvis ; Pelvis - injuries ; Penetrating trauma ; Perineum - injuries ; Peritonitis ; Prospective Studies ; Rectum ; Scanning ; Shootings ; Stability ; Surgery ; Tomography, X-Ray Computed ; Trauma ; Trauma Severity Indices ; Treatment Outcome ; Urinary bladder ; Wounds ; Wounds, Gunshot - diagnosis ; Wounds, Gunshot - therapy ; Young Adult</subject><ispartof>The American journal of surgery, 2011-06, Vol.201 (6), p.784-788</ispartof><rights>Elsevier Inc.</rights><rights>2011 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Jun 1, 2011</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c477t-c67e9cd180e5923c32050b8a72b0ad1da72179cd58d576bad4a58517ebe269cc3</citedby><cites>FETCH-LOGICAL-c477t-c67e9cd180e5923c32050b8a72b0ad1da72179cd58d576bad4a58517ebe269cc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1925191463?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72341</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24358375$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20883972$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Navsaria, Pradeep H., F.C.S.(S.A.), M.Med. (Surg.)</creatorcontrib><creatorcontrib>Edu, Sorin, F.C.S.(S.A.)</creatorcontrib><creatorcontrib>Nicol, Andrew J., F.C.S.(S.A.)</creatorcontrib><title>Nonoperative management of pelvic gunshot wounds</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Abstract Background The nonoperative management (NOM) of abdominal gunshot injuries is gradually becoming the standard of care. Patients with pelvic gunshot injuries constitute a subgroup of patients at high risk of visceral injury. The aim of this study was to assess the feasibility and safety of the selective NOM of pelvic gunshot injuries. Patients and methods This prospective study was performed from April 1, 2004, to November 30, 2008. Patients with pelvic gunshot injuries underwent laparotomy for peritonitis, hemodynamic instability, rectal bleeding, and urologic injuries. Patients with benign abdominal findings with hematuria underwent computed tomography scanning with intravenous contrast. Stable patients with no tenderness or minimal tenderness confined to the wound or wound tract underwent serial abdominal examination. Outcome parameters included need for delayed laparotomy, complications, length of hospital stay, and survival. Results During the 54-month study period, 239 patients with pelvic gunshot injuries were treated. One hundred seventy-six (73.6%) patients underwent immediate laparotomy, whereas 63 (26.4%) were selected for NOM. The nontherapeutic laparotomy rate was 4.5% in the former group, and no patient required delayed laparotomy in the latter group. Also, 3 patients with minor extraperitoneal bladder injuries were successfully managed nonoperatively. Associated injuries included mostly fractures to the bony pelvis including the iliac blade (19), pubic ramii (3), and acetabulum (3). The mean hospital stay was 2.2 (range 1–8) days in the nonoperative group of patients. There were no deaths. Conclusions Selective NOM of pelvic gunshot injuries is a feasible, safe, and effective alternative to routine laparotomy.</description><subject>Abdomen</subject><subject>Abdominal gunshot wounds</subject><subject>Acetabulum</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Antibiotics</subject><subject>Benign</subject><subject>Biological and medical sciences</subject><subject>Bladder</subject><subject>Bleeding</subject><subject>Complications</subject><subject>Computed tomography</subject><subject>Drainage - methods</subject><subject>Fatalities</subject><subject>Feasibility studies</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Fractures</subject><subject>General aspects</subject><subject>Health risks</subject><subject>Hematuria</subject><subject>Humans</subject><subject>Ilium - injuries</subject><subject>Injuries</subject><subject>Intravenous administration</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multiple Trauma - diagnosis</subject><subject>Multiple Trauma - therapy</subject><subject>Nonoperative management</subject><subject>Patients</subject><subject>Pelvic gunshot wounds</subject><subject>Pelvis</subject><subject>Pelvis - injuries</subject><subject>Penetrating trauma</subject><subject>Perineum - injuries</subject><subject>Peritonitis</subject><subject>Prospective Studies</subject><subject>Rectum</subject><subject>Scanning</subject><subject>Shootings</subject><subject>Stability</subject><subject>Surgery</subject><subject>Tomography, X-Ray Computed</subject><subject>Trauma</subject><subject>Trauma Severity Indices</subject><subject>Treatment Outcome</subject><subject>Urinary bladder</subject><subject>Wounds</subject><subject>Wounds, Gunshot - diagnosis</subject><subject>Wounds, Gunshot - therapy</subject><subject>Young Adult</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</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>eNqFkVuP1CAUgInRuOPqT9A0Mcanjhwohb5ozMZbstEH9ZlQODNSWxihHbP_XpoZ3WRffOJAvnPhO4Q8BboFCu2rYWumIS9pv2W0vFG-pdDcIxtQsqtBKX6fbCilrO5aoBfkUc5DuQI0_CG5YLQAnWQbQj_HEA-YzOyPWE0mmD1OGOYq7qoDjkdvq_0S8o84V7_jElx-TB7szJjxyfm8JN_fv_t29bG-_vLh09Xb69o2Us61bSV21oGiKDrGLWdU0F4ZyXpqHLgSgCyAUE7ItjeuMUIJkNgjaztr-SV5eap7SPHXgnnWk88Wx9EEjEvWSragRCN5IZ_fIYe4pFCG09AxAR007UqJE2VTzDnhTh-Sn0y60UD1alQP-mxUr0Y15boYLXnPztWXfkL3L-uvwgK8OAMmWzPukgnW51uu4UJxKQr35sRhsXb0mHS2HoNF5xPaWbvo_zvK6zsV7OiDL01_4g3m21_rzDTVX9f1r9uHEvAGJP8D3bCqMA</recordid><startdate>20110601</startdate><enddate>20110601</enddate><creator>Navsaria, Pradeep H., F.C.S.(S.A.), M.Med. (Surg.)</creator><creator>Edu, Sorin, F.C.S.(S.A.)</creator><creator>Nicol, Andrew J., F.C.S.(S.A.)</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><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>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</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>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20110601</creationdate><title>Nonoperative management of pelvic gunshot wounds</title><author>Navsaria, Pradeep H., F.C.S.(S.A.), M.Med. (Surg.) ; Edu, Sorin, F.C.S.(S.A.) ; Nicol, Andrew J., F.C.S.(S.A.)</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c477t-c67e9cd180e5923c32050b8a72b0ad1da72179cd58d576bad4a58517ebe269cc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Abdomen</topic><topic>Abdominal gunshot wounds</topic><topic>Acetabulum</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Antibiotics</topic><topic>Benign</topic><topic>Biological and medical sciences</topic><topic>Bladder</topic><topic>Bleeding</topic><topic>Complications</topic><topic>Computed tomography</topic><topic>Drainage - methods</topic><topic>Fatalities</topic><topic>Feasibility studies</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Fractures</topic><topic>General aspects</topic><topic>Health risks</topic><topic>Hematuria</topic><topic>Humans</topic><topic>Ilium - injuries</topic><topic>Injuries</topic><topic>Intravenous administration</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multiple Trauma - diagnosis</topic><topic>Multiple Trauma - therapy</topic><topic>Nonoperative management</topic><topic>Patients</topic><topic>Pelvic gunshot wounds</topic><topic>Pelvis</topic><topic>Pelvis - injuries</topic><topic>Penetrating trauma</topic><topic>Perineum - injuries</topic><topic>Peritonitis</topic><topic>Prospective Studies</topic><topic>Rectum</topic><topic>Scanning</topic><topic>Shootings</topic><topic>Stability</topic><topic>Surgery</topic><topic>Tomography, X-Ray Computed</topic><topic>Trauma</topic><topic>Trauma Severity Indices</topic><topic>Treatment Outcome</topic><topic>Urinary bladder</topic><topic>Wounds</topic><topic>Wounds, Gunshot - diagnosis</topic><topic>Wounds, Gunshot - therapy</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Navsaria, Pradeep H., F.C.S.(S.A.), M.Med. (Surg.)</creatorcontrib><creatorcontrib>Edu, Sorin, F.C.S.(S.A.)</creatorcontrib><creatorcontrib>Nicol, Andrew J., F.C.S.(S.A.)</creatorcontrib><collection>Pascal-Francis</collection><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>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</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>Engineering Research Database</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>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</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>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Navsaria, Pradeep H., F.C.S.(S.A.), M.Med. (Surg.)</au><au>Edu, Sorin, F.C.S.(S.A.)</au><au>Nicol, Andrew J., F.C.S.(S.A.)</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Nonoperative management of pelvic gunshot wounds</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2011-06-01</date><risdate>2011</risdate><volume>201</volume><issue>6</issue><spage>784</spage><epage>788</epage><pages>784-788</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><coden>AJSUAB</coden><abstract>Abstract Background The nonoperative management (NOM) of abdominal gunshot injuries is gradually becoming the standard of care. Patients with pelvic gunshot injuries constitute a subgroup of patients at high risk of visceral injury. The aim of this study was to assess the feasibility and safety of the selective NOM of pelvic gunshot injuries. Patients and methods This prospective study was performed from April 1, 2004, to November 30, 2008. Patients with pelvic gunshot injuries underwent laparotomy for peritonitis, hemodynamic instability, rectal bleeding, and urologic injuries. Patients with benign abdominal findings with hematuria underwent computed tomography scanning with intravenous contrast. Stable patients with no tenderness or minimal tenderness confined to the wound or wound tract underwent serial abdominal examination. Outcome parameters included need for delayed laparotomy, complications, length of hospital stay, and survival. Results During the 54-month study period, 239 patients with pelvic gunshot injuries were treated. One hundred seventy-six (73.6%) patients underwent immediate laparotomy, whereas 63 (26.4%) were selected for NOM. The nontherapeutic laparotomy rate was 4.5% in the former group, and no patient required delayed laparotomy in the latter group. Also, 3 patients with minor extraperitoneal bladder injuries were successfully managed nonoperatively. Associated injuries included mostly fractures to the bony pelvis including the iliac blade (19), pubic ramii (3), and acetabulum (3). The mean hospital stay was 2.2 (range 1–8) days in the nonoperative group of patients. There were no deaths. Conclusions Selective NOM of pelvic gunshot injuries is a feasible, safe, and effective alternative to routine laparotomy.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>20883972</pmid><doi>10.1016/j.amjsurg.2010.03.014</doi><tpages>5</tpages></addata></record> |
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| subjects | Abdomen Abdominal gunshot wounds Acetabulum Adolescent Adult Antibiotics Benign Biological and medical sciences Bladder Bleeding Complications Computed tomography Drainage - methods Fatalities Feasibility studies Female Follow-Up Studies Fractures General aspects Health risks Hematuria Humans Ilium - injuries Injuries Intravenous administration Length of Stay Male Medical imaging Medical sciences Middle Aged Multiple Trauma - diagnosis Multiple Trauma - therapy Nonoperative management Patients Pelvic gunshot wounds Pelvis Pelvis - injuries Penetrating trauma Perineum - injuries Peritonitis Prospective Studies Rectum Scanning Shootings Stability Surgery Tomography, X-Ray Computed Trauma Trauma Severity Indices Treatment Outcome Urinary bladder Wounds Wounds, Gunshot - diagnosis Wounds, Gunshot - therapy Young Adult |
| title | Nonoperative management of pelvic gunshot wounds |
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