Atypical gunshot wound: Bullet trajectory analyzed by computed tomography

Area of Science:

• Trauma Surgery
• Radiology
• Ballistics Medicine

Background:

• Gunshot injuries are a significant cause of morbidity and mortality.
• Atypical bullet trajectories can mask the extent of internal damage.
• Firearm-related injuries necessitate careful diagnostic and management strategies.

Purpose of the Study:

• To highlight a rare case of intra-abdominal injury from a distal limb gunshot wound.
• To emphasize the diagnostic challenges posed by atypical bullet trajectories.
• To underscore the importance of timely and accurate medical and surgical management.

Main Methods:

• Case report of a 63-year-old male with a gunshot wound to the left knee.
• Computed tomography (CT) scans to delineate the bullet's trajectory and organ damage.
• Surgical intervention involving sigmoid colectomy and descending colostomy.

Main Results:

• The bullet followed a subcutaneous path from the knee into the peritoneal cavity.
• Perforation of the distal descending colon was identified.
• The bullet lodged near the spleen and posterior chest wall without causing vital organ injury.
• The patient underwent successful surgery and recovered without complications.

Conclusions:

• Intra-abdominal organ damage from distal extremity gunshot wounds is uncommon.
• Atypical trajectories can lead to delayed diagnosis, inaccurate radiological interpretation, and suboptimal management.
• Accurate CT analysis and decisive surgical/medical management are vital for optimal patient outcomes.