Sarcouncil Journal of Medicine and Surgery

Abstract: Introduction Penetrating abdominal trauma (PAT), caused by gunshot wounds (GSW) or stab wounds (SW), remains a leading cause of trauma admissions at Baghdad Teaching Hospital. While exploratory laparotomy was traditionally the standard treatment to prevent contamination and hemorrhage, it often leads to high rates of non-therapeutic laparotomies. These unnecessary procedures increase hospital costs, prolong stays, and risk complications such as wound infections, adhesions, and incisional hernias. Selective non-operative management (SNOM) has emerged as a strategy to minimize these risks in hemodynamically stable patients. Methods A prospective study was conducted at Baghdad Teaching Hospital from January 2016 to May 2017. The study included 286 patients with PAT (GSW vs. SW). Patients underwent primary survey and resuscitation followed by clinical examination and imaging, including FAST and CT scans where indicated. Immediate laparotomy was performed for patients with hemodynamic instability, peritonitis, evisceration, or evidence of diaphragmatic injury. Stable patients without these indications were selected for non-operative management. Results Of the 286 patients received, 227 (79.4%) suffered gunshot wounds and 59 (20.6%) suffered stab wounds. Surgical intervention was performed in 198 patients (69.23%), while 88 patients (30.77%) were managed conservatively. Among those managed conservatively, 67 (76.1%) were successfully discharged without surgery. The remaining 21 patients (23.9%) failed conservative management and required surgery within 3–5 days. Conclusion Selective non-operative management is a necessary and effective approach for clinically stable patients with penetrating abdominal trauma. Utilizing contrast-enhanced CT scans and diagnostic laparoscopy alongside serial clinical examinations can significantly reduce the frequency of non-therapeutic explorations. While minimizing unnecessary surgery is vital, it must not delay the diagnosis and treatment of life-threatening injuries. Stable patients with tangential GSWs or SWs without signs of peritonitis can often be safely observed and discharged after 24 hours.