World Journal of Surgery

, Volume 35, Issue 1, pp 27–33 | Cite as

Management of Penetrating Abdominal Trauma in the Conflict Environment: The Role of Computed Tomography Scanning

  • Jonathan J. MorrisonEmail author
  • Jon C. Clasper
  • Iain Gibb
  • Mark Midwinter



Computed tomography (CT) scanning is a vital imaging technique in selecting patients for nonoperative management of civilian penetrating abdominal trauma. This has reduced the rate of nontherapeutic laparotomies and associated complications. Battlefield abdominal injuries conventionally mandate laparotomy, and with the advent of field deployable CT scanners it is unclear whether some ballistic injuries can be managed conservatively.


A retrospective 12 month cohort of patients admitted to a forward surgical facility in Afghanistan who sustained penetrating abdominal injury severe enough to warrant laparotomy or CT scan were studied. Patient details were retrieved from a prospectively maintained operative log and CT logs. Case notes were then reviewed and data pertaining to injury pattern, operative intervention, and survival were collected.


A total of 133 patients were studied: 73 underwent immediate laparotomy (Lap group) and 60 underwent CT scanning (CT group). Of those undergoing CT scanning 17 underwent laparotomy and 43 were selected for nonoperative management. There were 15 deaths in the Lap group and none in the CT group. The median New Injury Severity and Revised Trauma Score was 29 and 7.55 in the Lap group and 9 and 7.8408 in the CT group, which is statistically significantly different (p < 0.001). Five patients in the CT-Lap group had nontherapeutic laparotomies and 1 patient failed nonoperative management.


Computed tomography scanning can be used in stable patients who have sustained penetrating battlefield abdominal injury to exclude peritoneal breach and identify solid abdominal organ injury that can be safely managed nonoperatively.


Abdominal Trauma Nonoperative Management Gunshot Wound Revise Trauma Score Solid Organ Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors are grateful to the personnel of 204 Field Hospital who helped with the identification of patient case notes.


  1. 1.
    Moore EE, Moore JB, van Duzer-Moore S et al (1980) Mandatory laparotomy for gunshot wounds penetrating the abdomen. Am J Surg 140:847–851CrossRefPubMedGoogle Scholar
  2. 2.
    Sirinek KR, Page CP, Root HD et al (1990) Is exploratory celiotomy necessary for all patients with truncal stab wounds? Arch Surg 125:844–848PubMedGoogle Scholar
  3. 3.
    Leppaniemi A, Salo J, Haapiainen R (1995) Complications of negative laparotomy for truncal stab wounds. J Trauma 38:54–58CrossRefPubMedGoogle Scholar
  4. 4.
    Renz BM, Feliciano DV (1995) Unnecessary laparotomies for trauma: a prospective study of morbidity. J Trauma 38:350–356CrossRefPubMedGoogle Scholar
  5. 5.
    Thanvendran A, Vijayaragavan A, Rasaratnam R (1975) Selective surgery for abdominal stab wounds. Br J Surg 62:750–752CrossRefGoogle Scholar
  6. 6.
    Muckart DJ, Abdool-Carim AT, King B (1990) Selective conservative management of abdominal gunshot wounds: a prospective study. Br J Surg 77:652–655CrossRefPubMedGoogle Scholar
  7. 7.
    Velmahos GC, Demetriades D, Toutouzas KG et al (2001) Selective nonoperative management of 1,856 patients with abdominal gunshot wounds: should routine laparotomy still be the standard of care? Ann Surg 234:395–403CrossRefPubMedGoogle Scholar
  8. 8.
    Shanmuganathan K, Mirvis SE, Chiu W et al (2004) Penetrating torso trauma: triple-contrast helical CT in peritoneal violation and organ injury—a prospective study in 200 patients. Radiology 231:775–784CrossRefPubMedGoogle Scholar
  9. 9.
    Mahoney PF, Ryan JM, Brooks AJ et al (2005) Ballistic trauma, 2nd edn. Springer, LondonGoogle Scholar
  10. 10.
    O’Reilly DJ, Kilbey J (2007) Analysis of the initial 100 scans from the first CT scanner deployed by the British Armed Forces in a land environment. J R Army Med Corp 153:165–167Google Scholar
  11. 11.
    Statler JD, Tempel CG, Harcke HT et al (2005) Computed tomography of craniofacial trauma at a combat support hospital in Afghanistan. Mil Med 170:206–210PubMedGoogle Scholar
  12. 12.
    Mabry RL, Holcomb JB, Baker AM et al (2000) United States Army Rangers in Somalia: an analysis of combat casualties on an urban battlefield. J Trauma 49:515–529CrossRefPubMedGoogle Scholar
  13. 13.
    Beekley AC, Blackbourne LH, Sebesta JA et al (2008) Selective nonoperative management of penetrating torso injury from combat fragmentation wounds. J Trauma 64:s108–s117CrossRefPubMedGoogle Scholar
  14. 14.
    Champion HR, Bellamy RF, Roberts P et al (2003) A profile of combat injury. J Trauma 54:s13–s19PubMedGoogle Scholar
  15. 15.
    Osler T, Baker SP, Long W (1997) A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma 43:922–925 (discussion 925–926)CrossRefPubMedGoogle Scholar
  16. 16.
    Association for the Advancement of Automotive Medicine, Committee on Injury Scaling (1990) The abbreviated injury scale—1990 revision (AIS-90). Association for the Advancement of Automotive Medicine, Des PlainsGoogle Scholar
  17. 17.
    Cripps NP, Glover MA, Guy RJ (1999) The pathophysiology of primary blast injury and its implications for treatment. Part II: the auditory structures and abdomen. J R Nav Med Serv 85:13–24PubMedGoogle Scholar
  18. 18.
    Renz BM, Feliciano DV (1994) Gunshot wounds to the right thoracoabdomen: a prospective study of nonoperative management. J Trauma 37:737–744CrossRefPubMedGoogle Scholar
  19. 19.
    Eastern Association for the Surgery of Trauma, Practice Management Guideline Committee (2010) Practice management guidelines for nonoperative management of penetrating abdominal traumaGoogle Scholar
  20. 20.
    Soffer D, McKenney MG, Cohn S et al (2004) A prospective evaluation of ultrasonography for the diagnosis of penetrating torso injury. J Trauma 56:953–957CrossRefPubMedGoogle Scholar
  21. 21.
    Udobi KF, Rodriguez A, Chiu WC et al (2001) Role of ultrasonography in penetrating abdominal trauma: a prospective clinical study. J Trauma 50:475–479CrossRefPubMedGoogle Scholar
  22. 22.
    Asensio JA, Arroyo H, Veloz W et al (2002) Penetrating thoracoabdominal injuries: ongoing dilemma—which cavity and when? World J Surg 26:539–543CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Jonathan J. Morrison
    • 1
    Email author
  • Jon C. Clasper
    • 1
  • Iain Gibb
    • 2
  • Mark Midwinter
    • 1
  1. 1.Academic Department of Military Surgery and TraumaRoyal Centre for Defence MedicineBirminghamUK
  2. 2.Centre for Defence ImagingGosportUK

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