Management of Abdominal Gunshot Injuries: Surgical Intervention or Conservative Follow-Up? A Single-Center Experience

Abstract

BACKGROUND: This study aims to retrospectively evaluate treatment approaches and clinical outcomes in patients with penetrating abdominal trauma caused by gunshot injuries—one of the most complex and controversial areas in trauma surgery. METHODS: A total of 101 patients diagnosed and treated for penetrating abdominal trauma due to gunshot injuries between 2015 and 2025 were included in the study. Demographic data (age and sex); vital signs at admission to the emergency department (blood pressure, pulse, respiratory rate, body temperature); level of consciousness (Glasgow Coma Scale); hemodynamic status (stability/ instability, need for fluid or inotropic support); intra-abdominal (liver, spleen, small intestine, colon, etc.) and extra-abdominal (thorax, extremities, head, etc.) organ injuries; laboratory findings (hemoglobin, leukocyte count, creatinine, pH level); treatment modality (surgical intervention or conservative management); surgical techniques used; blood and blood product transfusions; and hospital length of stay were retrospectively analyzed. Patients were divided into two groups: those who underwent surgical treatment and those managed conservatively. Factors influencing treatment decisions and variables affecting mortality were evaluated statistically. RESULTS: Of the patients, 83.2% were male, with a mean age of 28.3±10.5 years. Surgical treatment was performed in 81.2% of cases, while 18.8% received conservative management. No mortality occurred in the conservatively managed group, whereas the surgically treated group had a mortality rate of 15.9%. Mortality among female patients (29.4%) was significantly higher than among males (9.5%) (p=0.026). Hemodynamic instability, intra-abdominal organ injury, presence of free air in the abdomen, and the need for blood product transfusion were associated with both the decision for surgical intervention and higher mortality. Additionally, damage control surgery and multiple organ injuries were linked to increased mortality. CONCLUSION: Management of abdominal trauma caused by gunshot injuries requires a multidisciplinary approach to ensure appropriate patient selection and treatment planning. In hemodynamically stable patients, selective non-operative management (SNOM) is a safe and effective option, whereas surgical intervention—particularly in cases requiring damage control surgery—is associated with higher mortality. The increased mortality rate among female patients underscores the need for closer monitoring of this subgroup and further investigation into potential additional risk factors. These findings align with current literature and provide practical guidance for clinical decision-making. © 2025 Elsevier B.V., All rights reserved.