Mandatory laparotomy for gunshot wounds penetrating the abdomen

A 4 year experience with 245 patients with isolated lower thoracic or anterior abdominal gunshot wounds was reviewed. Twenty-three (16 percent) of the 144 abdominal injuries were clinically superficial and all were managed successfully nonoperatively. Of the remaining 121 patients, 115 were confirmed to have peritoneal violation at laparotomy and 111 (96 percent) of these had significant visceral injuries. Of the 101 patients with lower chest wounds, 47 had peritoneal violation and 45 (96 percent) had intrabdominal injuries. Twenty-six (17 percent) of the 156 patients with intraperitoneal trauma had unimpressive physical signs on admission. These findings support a policy of routine exploration for gunshot wounds violating the peritoneum. When depth of penetration is uncertain, diagnostic peritoneal lavage should be used. Only those patients with unequivocally superficial injuries warrant observation.