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A new tailored protocol based on laparoscopy in the management of abdominal shotgun injuries: a case-series study

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

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.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit.

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Authors and Affiliations

  1. Department of General and Laparoscopic Surgery, Cairo University Hospitals (Kasr Alainy Hospital), 8 NourEldin Bahgat St, Nasr City, Cairo, Egypt

    Doaa Ahmed Mansour

  2. Department of General and Laparoscopic Surgery, Cairo University Hospitals (Kasr Alainy Hospital), Sama-Cairo block W1, Ring Road, Maadi, Cairo, Egypt

    Ahmed Mohammed Elshaer

  3. Department of General and Laparoscopic Surgery, Cairo University Hospitals (Kasr-Alainy Hospital), 41 Noubar St, Babelouk, Cairo, Egypt

    Mostafa Abd-Rahman Elshazly

Authors
  1. Doaa Ahmed Mansour
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  2. Ahmed Mohammed Elshaer
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  3. Mostafa Abd-Rahman Elshazly
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Corresponding author

Correspondence to Doaa Ahmed Mansour.

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Conflict of interest

Doaa Ahmed Mansour, Ahmed Mohammed Elshaer and Mostafa Abd-Rahman Elshazly declare that they have no conflict of interest.

Ethical approval

Approval was given by the Ethical Committee for Researches of General Surgery Department, Cairo University hospital and the Research committee of Faculty of medicine, Cairo University.

Additional information

This work was done in Cairo University Hospitals (Kasr Alainy Hospital), Elmanial, Cairo, Egypt.

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Mansour, D.A., Elshaer, A.M. & Elshazly, M.AR. A new tailored protocol based on laparoscopy in the management of abdominal shotgun injuries: a case-series study. Eur J Trauma Emerg Surg 46, 607–613 (2020). https://doi.org/10.1007/s00068-018-1015-7

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  • DOI: https://doi.org/10.1007/s00068-018-1015-7

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