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

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.