Operative Versus Selective Non‐operative Management in Adult Penetrating Abdominal Trauma With Bowel or Omental Evisceration: A Systematic Review and Meta‐Analysis

Abstract

BACKGROUND: Penetrating abdominal trauma with bowel or omental evisceration has traditionally mandated exploratory laparotomy due to perceived high risk of intra-abdominal injury. Selective nonoperative management (SNOM) has gained acceptance in stable patients, but evidence specific to evisceration remains limited and controversial. OBJECTIVE: To compare outcomes of operative management versus SNOM in adults with penetrating abdominal trauma and documented evisceration. METHODS: Systematic review conducted per PRISMA 2020 guidelines. Databases searched were as follows: PubMed, Scopus, Wits Summon, and Google Scholar (1980-2025). Inclusion were as follows: adults ≥ 18 years, penetrating (stab/gunshot) trauma, documented bowel/omental evisceration, operative versus SNOM comparison, and outcomes (mortality, missed injuries, delayed therapeutic laparotomy, complications, and length of stay). Risk of bias via Newcastle-Ottawa Scale; evidence certainty via GRADE. Random-effects meta-analysis performed where feasible PROSPERO registration number: (CRD420261345559). RESULTS: = 26%; and p < 0.001) without increased mortality or morbidity. Subgroup analysis showed SNOM particularly safe in isolated omental evisceration (failure < 15%), with higher therapeutic rates in bowel/organ cases. Evidence certainty was moderate (downgraded for observational design and heterogeneity). CONCLUSIONS: In hemodynamically stable patients with penetrating abdominal trauma and evisceration, SNOM appears safe and preferable in selected cases reducing unnecessary laparotomies without compromising outcomes. Prospective trials are needed to refine indications.