[Abdominal gunshot wounds: possibilities for selective conservative management].

Two men aged 45 and 26 years, respectively, presented with abdominal gunshot wounds and were treated successfully using a nonsurgical approach. Normally, abdominal gunshot wounds are treated surgically in the Netherlands. This policy produces negative laparotomy findings in 22-41% of procedures. With an increasing number of gunshot wound patients presenting to emergency departments, a better understanding of abdominal gunshot wounds is needed. Immediate laparotomy is indicated for patients with haemodynamic instability, signs of peritonitis or massive intra-abdominal fluid visible with focused abdominal ultrasonography for trauma. However in selected cases and with the use of strict diagnostic and follow-up procedures, it is possible to treat these patients with a nonsurgical approach. Physical examination, adequate CT investigation and possibly additional radiological evaluation play a pivotal role in this approach. Therefore, assessment by a multidisciplinary trauma team is crucial at the time of presentation and during further treatment for abdominal gunshot wounds. Ned Tijdschr Geneeskd.