Infection about the spine associated with low-velocity-missile injury to the abdomen.

We reviewed the cases of twenty patients who had a fracture or disruption of the disc space of a lower thoracic or lumbar vertebra that was associated with a low-velocity-missile wound to the abdomen. All of the patients underwent an exploratory laparotomy at the time of admission and all received broad-spectrum antibiotics for a minimum of two days. None of the patients had an immediate laminectomy or an immediate debridement of the paraspinal area. In eight patients the gastrointestinal tract was not perforated, and none of them had evidence of infection. In four patients the stomach and small bowel were perforated by the bullet before it struck the vertebral column, and none of them had meningitis, paraspinal infection, or osteomyelitis. In contrast, meningitis, paraspinal infection, or osteomyelitis did develop in seven of eight patients in whom the bullet perforated the colon before it hit the vertebra. Perforation of the colon by a low-velocity missile before the missile fractured the thoracic or lumbar vertebra was associated with a high incidence of infection. The appropriate management may require early operative intervention. This is in contrast to the non-operative approach that has been advocated for low-velocity gunshot wounds to the spine. We agree that a non-operative approach is indicated for gunshot wounds of the abdomen that do not involve the colon.