Assessment of Extent and Severity of Pellet Induced Abdominal Injuries, a Rare Variant of Weapon Violence: A Prospective Study

Abstract

Background: The use of a Pellet gun, a form of short gun used for mob control in many conflict zones, has posed a serious challenge to the surgeons in assessing the extent of trauma caused by these pellets. Objectives: To study the role of conventional available investigations for trauma like ultrasonography and computed tomography scans in assessing the severity of the injuries caused by the pellets. Methodology: 50 patients having pellet injuries predominantly in abdomen without other associated trauma were included in the study. The decision for surgery was taken on the basis of clinical and CECT (Contrast Enhanced Computed Tomography) findings and these findings were then compared with intra-operative findings. Results: 30/50 patients were decided to be operated on the basis of Clinical and CECT findings. On exploration, it was observed that 18/33 patients really needed exploration while as 15/33 patients could have been managed conservatively. This was observed in next 20/50 patients who were put on conservative management with similar CECT findings. Of these 20 patients, 17 did well while as 3 were explored later in view of developing peritonitis and were found to have small bowel perforations. Conclusion: Conventional investigations for trauma like FAST and CECT abdomen are not ideal for assessing the severity of pellet induced abdominal visceral injuries which result in high rate of unnecessary laparotomies. Also the abdominal pellet trauma patients can be well managed conservatively until hemodynamically stable even though CT scan shows pellet penetration into peritoneal cavity or bowel lumen.