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Brazilian Journal of Clinical Medicine and Review

Mini Review

Vol. 4 No. 1 (2026): January/December - 2026

Selective Nonoperative Management of Abdominal Gunshot Wounds: Contemporary Protocols, Patient Selection, and Failure Rescue

DOI
https://doi.org/10.52600/2965-0968.bjcmr.2026.4.1.bjcmr53
Submitted
January 22, 2026
Published
2026-02-13

Abstract

Penetrating abdominal trauma caused by firearm injuries has traditionally been managed with mandatory exploratory laparotomy. Advances in imaging, critical care, and clinical monitoring have progressively supported selective nonoperative management (NOM) in carefully selected patients, challenging historical dogma and reducing nontherapeutic laparotomy rates. To review contemporary evidence and protocols guiding nonoperative management of abdominal gunshot wounds, with emphasis on patient selection, diagnostic strategies, monitoring protocols, and criteria for conversion to operative intervention. A structured narrative review was conducted using PubMed/MEDLINE, Scopus, and SciELO databases. A total of 247 records were identified, of which 20 articles met predefined inclusion criteria and were selected for qualitative synthesis. Evidence supports selective nonoperative management in hemodynamically stable patients without signs of peritonitis, provided that structured protocols and close monitoring are implemented. Computed tomography plays a central role in patient selection, while serial physical examinations remain essential for early detection of treatment failure. Reported success rates exceed 80–90% in experienced trauma centers. Protocol-driven nonoperative management of abdominal gunshot wounds is a safe and effective strategy in selected patients and should be integrated into modern trauma algorithms.

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