Defining the role of selective conservatism in abdominal shotgun injuries - Experience from a major trauma centre in South Africa

BACKGROUND: This study sets out to review our experience with the management of abdominal shotgun wounds (SGWs). The aim of this study was to review the spectrum, injury pattern, clinical outcome as well as the applicability of selective non-operative management (SNOM) to abdominal SGWs managed at our institution. METHODS: Patients presenting with abdominal gunshot wounds (GSWs) between January 2012 to December 2024, were retrospectively reviewed from the Hybrid Electronic Medical Registry (HEMR). During the same study period, direct comparison was made between abdominal GSWs and SGWs. Data included demographics, injury pattern, body region injuries, diagnostic imaging, operative interventions and clinical outcome. RESULTS: During the twelve-year study period, a total of 1060 patients sustained an abdominal GSW of which 41 (4 %) sustained an abdominal SGW and were included in the study. 30 abdominal SGW patients (73 %) required a laparotomy, and of these, 14 (47 %) were damage control laparotomies (DCL). There was a more liberal use of computed tomography (CT) scans in patients with SGWs (83 % versus 54 %, p < 0.001) however, there were no statistical significances in SNOM attempt rates (28 % versus 32 %, p = 0.602) and success rates (85 % versus 95 %, p = 0.161). CONCLUSION: The management of abdominal SGWs is challenging and imaging is essential due to the unpredictable behaviour of the multiple pellets. Although there is a significant rate of operation with a high rate of damage control surgery, a select cohort can be managed non-operatively without increased mortality.