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The extent of injuries due to gunshot depends on the ballistic properties of the bullet (energy, type, and stability) and the medium crossed. Gunshot wound at the thoracoabdominal region is commonly associated with life-threatening multisystemic injuries leading to high mortality and morbidity. In the presence of hemodynamic instability, emergent surgical intervention is warranted. However, in stable patients Computed Tomography (CT) imaging is a feasible option and may play a crucial role.
We present a case of a criminal who was shot 3 times with a handgun by police officer from short distance with the aim of not to kill him as he is a wanted suspect to solve 40 armed robbery cases. Upon arrival, patient was in pain, restless, and in respiratory distress. Primary survey revealed two entry wounds over the right thoraco-abdominal region with no exit wound seen and another through and through wound over his right forearm. Air entries were equal bilaterally and abdomen was tender over Rt upper quadrant. Extended FAST showed minimal free fluid at the Morrison’s pouch. He was intubated, and followed by x-rays and CT imaging as he remained hemodynamically stable. CT imaging demonstrated presence of two bullets; located over the left lobe of liver and left 9th intercostal space with surrounding hematoma associated with bilateral lower lobe pneumothorax, suspected right diaphragm defect and pneumoperitoneum with suspicion of bowel wall defect. X-ray showed comminuted fracture over the midshaft of right radius. He subsequently underwent exploratory laparotomy and external fixation of right forearm. Intraoperative findings were almost similar to CT findings. He was discharged well after 11 days.
In a gunshot injury, external wounds do not correlate well with internal injury as bullet trajectory is often unpredictable especially at the anatomical junctions. In hemodynamically stable patient, CT is a useful tool to delineate the extent of the injury and provides useful information to guide surgical intervention.
Evaluation with CT imaging should be considered following gunshot injuries in a carefully selected group of patients as it may provide precious information regarding the patient care plan.
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