Delayed Small Bowel Injury as a Result of Penetrating Extraperitoneal High-Velocity Ballistic Trauma to the Abdomen

Colonic Perforation from an Extraperitoneal Low-Velocity Gunshot Wound to the Abdomen

“…As mentioned in the two previous case reports [1,2], visceral injuries are caused by direct action of the missile passing through the tissues. In addition, high-velocity projectiles produce a local increase in pressure of up to 200 atmospheres, with an associated zone of tissue injury up to 7 cm [3,4] from the missile's track.…”

“…The perforation was repaired primarily, and the patient discharged after an uneventful recovery. Velitchkov et al [2] reported a second case, where an extraperitoneal gunshot wound was sustained from an AK-47 assault rifle. The intraabdominal injury did not become apparent until day 4.…”

“…Injuries to abdominal viscera from missiles which do not penetrate the peritoneal cavity are very rare with only two cases having been reported previously, both being associated with high-velocity missile wounds [1,2]. We report the first case of a perforation of colon by a lowvelocity missile which did not enter the peritoneal cavity.…”

Blast-Induced Colon Perforation Secondary to Civilian Gunshot Wound

“…The tissue damage caused by a bullet is determined in part by the kinetic energy of the bullet imparted to the body, but more importantly by the density and other physical properties of the injured tissue, and by the area of contact between the bullet and the tissue [1]. Depending on the length of travel through tissue, the 0.223 caliber bullet shot by an AR-15/M-16 rifle (muzzle velocity of 988 m/s or 3,241 feet/s) may inflict significant tissue damage.…”

“…Unlike penetrating injuries caused by most handgun bullets, those resulting from rifle bullets can cause significant injuries outside the actual path of the bullet. There are scattered reports of intestinal injury due to tangential extraperitoneal gunshot wounds [1,2]. Peritoneal lavage and laparoscopy have been suggested as diagnostic methods to identify occult bowel injuries in these cases.…”