This study aims to retrospectively evaluate treatment approaches and clinical outcomes in patients with penetrating abdominal trauma caused by gunshot injuries-one of the most complex and controversial areas in trauma surgery. A total of 101 patients diagnosed and treated for penetrating abdominal trauma due to gunshot injuries between 2015 and 2025 were included in the study. Demographic data (age and sex); vital signs at admission to the emergency department (blood pressure, pulse, respiratory rate, body temperature); level of consciousness (Glasgow Coma Scale); hemodynamic status (stability/instability, need for fluid or inotropic support); intra-abdominal (liver, spleen, small intestine, colon, etc.) and extra-abdominal (thorax, extremities, head, etc.) organ injuries; laboratory findings (hemoglobin, leukocyte count, creatinine, pH level); treatment modality (surgical intervention or conservative management); surgical techniques used; blood and blood product transfusions; and hospital length of stay were retrospectively analyzed. Patients were divided into two groups: those who underwent surgical treatment and those managed conservatively. Factors influencing treatment decisions and variables affecting mortality were evaluated statistically. Of the patients, 83.2% were male, with a mean age of 28.3+-10.5 years. Surgical treatment was performed in 81.2% of cases, while 18.8% received conservative management. No mortality occurred in the conservatively managed group, whereas the surgically treated group had a mortality rate of 15.9%. Mortality among female patients (29.4%) was significantly higher than among males (9.5%) (p=0.026). Hemodynamic instability, intra-abdominal organ injury, presence of free air in the abdomen, and the need for blood product transfusion were associated with both the decision for surgical intervention and higher mortality. Additionally, damage control surgery and multiple organ injuries were linked to increased mortality. Management of abdominal trauma caused by gunshot injuries requires a multidisciplinary approach to ensure appropriate patient selection and treatment planning. In hemodynamically stable patients, selective non-operative management (SNOM) is a safe and effective option, whereas surgical intervention-particularly in cases requiring damage control surgery-is associated with higher mortality. The increased mortality rate among female patients underscores the need for closer monitoring of this subgroup and further investigation into potential additional risk factors. These findings align with current literature and provide practical guidance for clinical decision-making.

Background/Aim: Anastomotic stricture following choledochojejunostomy (CJS) is largely driven by fibrotic remodeling at the anastomotic site, a process mediated by transforming growth factor-β (TGF-β) signaling. This problem is particularly relevant in emergency biliary surgery, where CJS is frequently performed under suboptimal conditions and anastomotic leakage is common, predisposing to exaggerated fibrosis and late strictures. This study aimed to evaluate the effect of the TGF-β type I receptor (ALK5) inhibitor EW-7197 (vactosertib) on histopathological parameters of anastomotic healing, with a particular focus on fibrosis, in a rat CJS model. Materials and Methods: Twenty-four male Wistar Albino rats were randomized into three groups (n = 8 each): control (G1), CJS only (G2), and CJS plus EW-7197 (G3). EW-7197 was administered as a single intraperitoneal dose (20 mg/kg) immediately after completion of the anastomosis. On postoperative day 21, choledochojejunal anastomotic tissues were harvested and evaluated histologically using hematoxylin–eosin and Masson’s trichrome staining. Edema, hyperemia, inflammation, and fibrosis were graded using a semi-quantitative scoring system, and intergroup comparisons were performed using non-parametric statistical tests. Results: Compared with surgery alone, EW-7197 treatment resulted in a statistically significant reduction in fibrosis severity at the anastomotic site (p < 0.001) and a significant attenuation of hyperemia (p = 0.007). Edema scores showed a downward trend in the EW-7197-treated group but did not reach statistical significance, while inflammation scores did not differ significantly between the surgical groups. Conclusions: In this experimental rat choledochojejunostomy model, administration of the selective ALK5 inhibitor EW-7197 significantly reduced histopathological fibrosis and hyperemia at the anastomotic site on postoperative day 21 without affecting inflammation severity. These findings support the role of the TGF-β/Smad pathway in bilioenteric anastomotic fibrotic remodeling. However, further studies including molecular validation and functional assessments are required to clarify the translational relevance of these results.

Omental torsion is a rare cause of acute abdominal pain, with an incidence rate of less than 0.37%. Due to its non-specific symptoms, it is often confused with other causes of acute abdominal pain, such as acute appendicitis. In this case presentation, we will discuss a 26-year-old male patient who presented to the emergency department with complaints of abdominal pain and was diagnosed with perioperative omental torsion. The diagnosis of omental torsion is challenging due to its non-specific symptoms. When a diagnosis cannot be established in acute pain, diagnostic laparoscopy should not be delayed. Omental torsion can be easily treated with laparoscopic omentectomy.