Abdominal Gunshot Wounds

Overview

This StatPearls review by Forbes and Burns, last updated in May 2022, covers the evaluation and treatment of abdominal gunshot wounds. These are multisystem injuries with high morbidity and mortality, and they account for up to 90% of the deaths from penetrating abdominal injury. The bullet's path is often unpredictable. The most commonly injured organs are the small bowel (about 50%), the large bowel (about 40%), the liver (about 40%) and the abdominal blood vessels (about 30%).

Evaluation

Assessment starts with airway, breathing and circulation, followed by a complete external examination for entry and exit wounds. Signs may include pain, abdominal distension, tenderness, guarding and rebound, rectal bleeding and unstable vital signs. The scene history, including the weapon and the number of shots, can help. In an unstable patient, extended FAST (EFAST) ultrasound looks for free fluid, pericardial tamponade and pneumothorax or haemothorax. If the patient is stable and has no peritonitis, CT can show free fluid, solid organ injury and active extravasation.

Management

Patients with peritonitis, haemodynamic instability, active bleeding or worsening clinical signs need immediate laparotomy, and surgery should not be delayed for further tests. Initial care includes controlling bleeding with pressure, fluid resuscitation, blood typing and a massive transfusion protocol where available. Tetanus prophylaxis, broad-spectrum antibiotics and analgesia are also considered. Non-operative management is possible for selected patients when clinical and imaging findings allow, with close serial examination.

Complications and outcome

Complications include exsanguination, inadequate resuscitation, peritonitis, intra-abdominal sepsis, fistula, wound problems and death. Most deaths occur in the first 24 hours. Care involves emergency medicine, trauma and general surgery, radiology and anaesthesia, and prevention through safe firearm storage is also emphasised.