Selective non-operative management of liver gunshot injuries

Background: In contrast to non-surgical treatment of blunt liver trauma, non-operative management (NOM) of fiver gunshot injuries (LGSIs) is not widely accepted. This prospective study evaluated an experience of NOM of gunshot wounds to the liver. Methods: All patients presenting with LGSIs who were haemodynamically stable with no evidence of peritonism underwent a protocol of NOM. Results: Thirty-three patients (mean age 25 (range 13-50) years) were enrolled over a 36-month period. Fourteen had grade III injuries according to the American Association for the Surgery of Trauma (AAST) classification, whereas 11 and eight patients sustained major (AAST IV/V) and minor (AAST I/II) injuries respectively. NOM was successful in 31 of 33 patients. Two patients required delayed laparotomy for indications unrelated to the hepatic trauma. One patient died from necrotizing fasciitis, which appeared unrelated to the liver injury. Conclusion: This study demonstrated that, regardless of the grade of fiver trauma, NOM is safe and effective in appropriately selected patients with LGSI treated in centres with suitable facilities.