Gunshot wounds. Personal experience

Background. Aim of the paper is to evaluate the gunshot wounds' severity in patients who reach the emergency room still alive and the possibility to adopt conservative treatment, instead of an aggressive one, for injured organs. Methods. A retrospective study has been carried out on 40 patients with gunshot wounds arrived at the Emergency Surgery Division of the Ospedale Vittorio Emanuele in Catania (average age: 32 years). Patients who died during transport or before any possible surgical treatment were ruled out of the study. Among 40 patients considered, 25 (62.5%) were affected only by skin and soft tissues lesions, 5 (12.5%) by lesions of soft tissues and bones, and 10 (25%) by single or multiple lesions of intrathoracic organs (pleura, lung), intraperitoneal organs (ileum, stomach, colon, liver, spleen, kidney, bladder) or vessels (carotids). Out of these 10 patients, 5 underwent a total or partial resection of organ (total splenectomy, total nephrectomy, ileal resection, liver resection) and 5 a simple repair or the insertion of a thoracic tube. Results. Two out of the 40 patients observed (5%) died for cardiocirculatory collapse secondary to inexorable bleeding, the first for multiple organ lesions, and the second for tears of carotid vessels. The remaining 38 patients (95%) had an uneventful course. Conclusions. Mortality of patients who reach the emergency room still alive is definitely low, probably because often they are young and without associated diseases. Such results have been reached also for the enormous progress in diagnostic tools and resuscitation means, which nowadays are available in modern Emergency Departments. As to surgical treatment, the conservative techniques, when feasible, allow as good results as more aggressive approaches.