Atypical Gunshot Injury Traversing the Neck with an Unexpected Nonlinear Bullet Trajectory: a Case Report and Review of the Literature

Abstract

Gunshot injuries involving the head and neck region yield profound morbidity and mortality rates. Projectile-related factors comprising various physical and dynamic properties of a bullet, as well as tissue-related factors, determine the disruptive effects of projectiles on living tissues. We experienced an extremely unusual case of a gunshot injury to the neck, wherein the bullet transversely penetrated across the deep neck structures to the contralateral side of the shoulder without damaging any vital organs. A 51-year-old man presented with a gunshot wound to the neck from a point-blank range. A bullet entry hole was observed on the left side of the neck without an exit hole; however, the patient was conscious, vital signs were normal, and no active bleeding, cranial nerve palsy, or aero-digestive tract injury was found. Imaging tests revealed a bullet lying in front of the right humeral head, which was extracted by emergency surgery. The patient was uneventfully discharged. According to the localization of the damaged tissues and the positional relationship between the bullet’s entrance and its destination, the bullet was estimated to have nonlinearly traversed the neck by traveling through the interstructural spaces associated with the least tissue resistance. Our experience strongly suggests the importance of realizing the unpredictable nature of a bullet trajectory in a body. An appropriate understanding of various ballistic factors and wounding mechanisms can be of great help in the adequate assessment and management of patients with gunshot injuries.

Retained bullet in the neck after gunshot wounds to the chest and arm in combat patient injured in the war in Ukraine: A case report

“…A gunshot wound is the most common injury in armed conflicts, resulting in severe trauma and increased morbidity usually due to damage to major vessels [1] , [2] , [3] . Since 2014 Russia aggression against Ukraine has been ongoing as a hybrid war with the subsequent beginning of active fights on February, 24th 2022 [4] .…”

Pure ballistic sonic pressure wave lung injury on computed tomography (CT) and plain radiograph

“…As described in literature, this pattern of injury is produced by an indirect effect of a bullet passing through the tissues without physical contact between both the tissue and projectile. It is a highly dynamic pressure phenomenon which involves a radial stretching of the tissue around the bullet tunnel, and at the point of impact, a stress wave is generated and rapidly spreads ahead from the maximum pressure point at the leading edge of the bullet [3] .…”

“…He was able to be discharged home with no solid vital organ injury after a-week stay in hospital. Though in Malaysia, we have rare occurrences of gunshot injury in emergency setting, but the consequences of ballistic injury can be quite damaging and unpredictable since it may be influenced by various physical and dynamic properties of a projectile, including its mass, caliber, trajectory, velocity, distance travelled and as well as spin motion [3] . A complex mechanism behind it can be manifested with perplexed medical and radiological findings – as uncommon as this one-of-a-kind case.…”

Gunshot injury to the face: a case report

“…Secondary injuries are also possible following impact with bone, which sets other missiles (bone fragments) into motion on their own paths, causing additional injury. [4][5][6] The face and neck region is packed with vital structures in a relatively small volume of space. Even the smallest of movements by a penetrating missile may injure a major vein, artery and main nerve trunk simultaneously.…”