Selective Nonoperative Management of a Pediatric Abdominal Gunshot Wound

TL;DR

A 17-year-old boy with a severe abdominal gunshot wound was successfully treated without surgery using selective nonoperative management and delayed embolization.

Contribution

This case demonstrates the safety and efficacy of selective nonoperative management in pediatric patients with penetrating abdominal trauma.

Findings

The patient was managed with serial exams and imaging instead of immediate surgery.

Angioembolization was performed successfully on hospital day 4 based on CT angiography findings.

The patient was discharged without complications on hospital day 6.

Abstract

The standard of care for penetrating abdominal trauma (PAT) has traditionally been exploratory laparotomy. However, significant rates of surgical morbidity and nontherapeutic laparotomies have prompted the development of alternative strategies. Selective nonoperative management (SNOM) is one such approach, which can be considered for hemodynamically stable patients without signs of peritonitis. We present the case of a 17-year-old male patient who sustained a gunshot wound (GSW) to the upper abdomen and right flank. Imaging revealed a grade IV liver laceration with active extravasation. The patient was admitted for serial abdominal exams, hematologic monitoring, and a scheduled computed tomography (CT) angiography in 72 hours. Interventional radiology performed embolization of multiple hepatic artery pseudoaneurysms on hospital day 4 based on the CT angiography findings. The patient was transitioned to a regular diet and was discharged without complication on hospital day 6. This case highlights the safety and efficacy of CT-guided SNOM and delayed angioembolization in pediatric patients with PAT.

Figures