Top

European Surgery

Published in:

01-12-2016 | original article

Missed injuries in patients with abdominal gunshot trauma: risk factors and mortality rates

Authors: M. Ugur, MD, S. Akkucuk, MD, Y. S. Koca, MD, C. Oruc, MD, A. Aydogan, MD

Published in: European Surgery | Issue 6/2016

Abstract

Introduction

The aim of this study was to investigate the incidence, risk factors, and mortality rates of injuries missed during laparotomy in patients with high-kinetic energy gunshot trauma.

Methods

The retrospective study included 20 patients who underwent relaparotomy due to high-kinetic energy gunshot trauma at our hospital between 2010 and 2015. Mechanism of injury, time between initial laparotomy and relaparotomy, the method of incision used for laparotomy during the initial laparotomy, the organs detected with missed injury, and the mortality rates were recorded.

Results

All the patients were male, with a mean age of 24.90 ± 5.2 years. Missed injuries were markedly more common in the patients who underwent incomplete incision during the initial laparotomy (p < 0.05). Mortality occurred in 11 (55 %) patients. In these patients, time between laparotomy and relaparotomy was longer and the Injury Severity Score (ISS) was significantly higher compared to other patients (p < 0.05).

Discussion

A complete midline incision allowing optimal exposure should be performed in patients with penetrating abdominal trauma caused by high-kinetic energy gunshot. A systematic surgical exploration should be performed, including meticulous inspection of all the intraabdominal and retroperitoneal organs.

Conclusion

Damage control surgery (DCS) should be performed in patients with severe trauma and hemodynamic instability. Proper administration of DCS may lead to reduced incidence of missed injuries and thus may decrease the mortality rates.

Buduhan G, McRitchie DI. Missed injuries in patients with multiple trauma. J Trauma. 2000;49(4):600–5.CrossRefPubMed

Eurin M, Haddad N, Zappa M, Lenoir T, Dauzac C, Vilgrain V, et al. Incidence and predictors of missed injuries in trauma patients in the initial hot report of whole-body CT scan. Injury. 2012;43(1):73–7.CrossRefPubMed

Enderson BL, Reath DB, Meadors J, Dallas W, DeBoo JM, Maull KI. The tertiary trauma survey: a prospective study of missed injury. J Trauma. 1990;30(6):666–70.CrossRefPubMed

Enderson BL, Maull KI. Missed injuries. The trauma surgeon’s nemesis. Surg Clin North Am. 1991;71(2):399–418.CrossRefPubMed

Giannou C, Baldan M, Molde A. Injuries to abdomen. In: Giannou C, Baldan M, Molde A, editors. War surgery vol 2. Geneva: International Committee of the Red Cross; 2013. pp. 421–82.

Orlando health surgical critical care and acute care surgery fellowships. injury severity scoring. http://www.surgicalcriticalcare.net/Resources/injury_severity_scoring.pdf. Access date: 27.04.2016

Trauma. injury severity score. http://www.trauma.org/archive/scores/iss.html. Access date: 27.04.2016

Muckart DJ, Thomson SR. Undetected injuries: a preventable cause of increased morbidity and mortality. Am J Surg. 1991;162(5):457–60.CrossRefPubMed

Biffl WL, Kaups KL, Cothren CC, Brasel KJ, Dicker RA, Bullard MK, et al. Management of patients with anterior abdominal stab wounds: a Western Trauma Association multicenter trial. J Trauma. 2009;66(5):1294–1301.CrossRefPubMed

10.

Melo EL, Menezes MR de, Cerri GG. Abdominal gunshot wounds: multi-detector-row CT findings compared with laparotomy: a prospective study. Emerg Radiol. 2012;19(1):35–41.CrossRefPubMed

11.

Giannou C, Baldan M. Neglected or mismanaged wounds. In: Giannou C, Baldan M, editors. War surgery vol 1. Geneva: International Committee of the Red Cross; 2013. pp. 243–51.

12.

Lee WC, Chen CW, Lin YK, Lin TY, Kuo LC, Cheng YC, et al. Association of head, thoracic and abdominal trauma with delayed diagnosis of co-existing injuries in critical trauma patients. Injury. 2014;45(9):1429–34.CrossRefPubMed

13.

Coupland RM. Epidemiological approach to surgical management of the casualties of war. BMJ. 1994;308:1693–96.CrossRefPubMedPubMedCentral

14.

Scalea TM, Phillips TF, Goldstein AS, Sclafani SJ, Duncan AO, Atweh NA, et al. Injuries missed at operation: nemesis of the trauma surgeon. J Trauma. 1988;28(7):962–7.CrossRefPubMed

15.

Moore EE, Burch JM, Franciose RJ, Offner PJ, Biffl WL. Staged physiologic restoration and damage control surgery. World J Surg. 1998;22(12):1184–90.CrossRefPubMed

16.

Cirocchi R, Montedori A, Farinella E, Bonacini I, Tagliabue L, Abraha I. Damage control surgery for abdominal trauma. Cochrane Database Syst Rev. 2013;2013:CD007438.

17.

Janjua KJ, Sugrue M, Deane SA. Prospective evaluation of early missed injuries and the role of tertiary trauma survey. J Trauma. 1998;44:1000–7.CrossRefPubMed

18.

Sung CK, Kim KH. Missed injuries in abdominal trauma. J Trauma. 1996;41:276–8.CrossRefPubMed

19.

Kalemoglu M, Demirbas S, Akin ML, Yildirim I, Kurt Y, Uluutku H, et al. Missed injuries in military patients with major trauma: original study. Mil Med. 2006;171(7):598–602.CrossRefPubMed

Title: Missed injuries in patients with abdominal gunshot trauma: risk factors and mortality rates
Authors: M. Ugur, MD
S. Akkucuk, MD
Y. S. Koca, MD
C. Oruc, MD
A. Aydogan, MD
Publication date: 01-12-2016
Publisher: Springer Vienna
Published in: European Surgery / Issue 6/2016
Print ISSN: 1682-8631
Electronic ISSN: 1682-4016
DOI: https://doi.org/10.1007/s10353-016-0411-7

ACC 2024 Congress

Springer Medicine

Missed injuries in patients with abdominal gunshot trauma: risk factors and mortality rates

Abstract

Introduction

Methods

Results

Discussion

Conclusion

ACC 2024 Congress

Springer Medicine

Abstract

Introduction

Methods

Results

Discussion

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2016

Experimental nerve transfer model in the rat forelimb

Surgical approach is superior to palliative treatment in oligometastatic lung cancer

Viability of five different pre- and intraoperative imaging methods for autologous breast reconstruction

Bariatrische Eingriffe in der Therapie des Diabetes mellitus Typ II

Programmed death-ligand 1 expression in rectal cancer

Cystic tumors of the pancreas