This prospective study of 78 patients who sustained abdominal gunshot wounds was performed to evaluate the pattern of injuries, treatment outcome and the role of selective conservative management. Three (3.8%) patients died before laparotomy. Four (5.1%) patients with superficial wounds were managed by local wound care. Fourteen (18%) patients who had equivocal or minimal abdominal signs were selected for conservative management. Laparotomy was performed in 57 (73.1%) patients who presented with an acute abdomen. The commonly injured organs were the small bowel (56.1%), colon (38.6%), liver (22.8%) and stomach (19.3%). Prolonged injury to arrival and surgical intervention time were contributing factors to the high incidence of sepsis (63.2%) and mortality (22.8%) after laparotomy. Two patients selected for conservative management required delayed laparotomy, one of which was negative. A 10-fold increase in prevalence of abdominal gunshot wounds has occurred in our institution in the 1990s. Selective conservative management is feasible without the use of expensive investigations.