Selective Nonoperative Management of a Pediatric Abdominal Gunshot Wound

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.

Keywords: angioembolization; pediatric trauma care; penetrating abdominal trauma; penetrating liver trauma; selective nonoperative management.

Figure 1. Computed tomography (CT) scan on hospital day 1 showing a grade IV liver laceration with active extravasation

Figure 2. Computed tomography (CT) angiography scan on hospital day 4 demonstrating pseudoaneurysms and active arterial extravasation (arrow)