Multiple thoracoabdominal gunshot wounds with complicated trajectories.

Area of Science:

• Trauma Surgery
• Ballistics
• Emergency Medicine

Background:

• A 41-year-old male sustained multiple gunshot wounds from a custom handgun.
• The incident resulted in two penetrating projectiles and one projectile recovered from a wall.

Observation:

• The patient presented with massive bleeding from a left supraclavicular gunshot wound and entered shock.
• Initial assessment revealed right hemothorax, necessitating resuscitation and chest drainage.
• Surgical exploration included left subclavicular incision, right thoracotomy, and laparotomy to address bleeding and potential organ damage.

Findings:

• Hemorrhage from the left subclavian vein was successfully controlled.
• Bleeding from the right lung was managed during thoracotomy.
• Laparotomy was performed to investigate the bullet's trajectory and rule out intra-abdominal injuries.

Implications:

• Managing thoracoabdominal gunshot wounds requires emergent surgical intervention.
• Accurate trajectory determination in multiple penetrating injuries is challenging.
• Prompt surgical control of hemorrhage is vital in patients with severe ballistic trauma.