Gunshot Injury Of Head And Neck Region With An Atypical Bullet Trajectory: The Importance Of Whole Body Computed Tomography Scan

Abstract

Nowadays, gunshot injuries have become a common medical-legal issue because of easy accessibility of firearms. Gunshot injuries of head and neck region are highly morbid and fatal, particularly when they affect vital organs. In rare cases, atypical tract lines resulting from such injuries can cause difficulties in the diagnosis and treatment. In this report, a high energy gunshot injury involving head and neck region with an atypical bullet trajectory is presented. A 24-year male soldier was brought to the emergency department on account of gunshot injury following a conflict. Although the entrance and exit holes of bullets were confined to head and neck region, the whole body computed tomography scan was carried out in spite of his borderline hemodynamics. Whole body computed tomography revealed massive hemopneumothorax, mediastinal shift, hepatic laceration, and foreign body (bullet) in the liver. The patient was operated successfully by a multidisciplinary surgical team on emergency basis. This report highlights the necessity and importance of whole body computed tomography scan in such cases.

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

“…In contrast to other studies, the identification of the bullet in our case was more complicated, because the patient had both inlet and outlet holes, and his initial management was performed in a civil hospital, which was widely organized for combat patients as a Level II in the early phase of Russian invasion to Ukraine during the February-Mach 2022. Our data shows that routine examination of the combat patient in a military hospital with gunshot injury by X-ray or CT scan is highly important to detect such rare cases and to provide high-specialized surgical care, which is consistent with other reports [13] , [14] .…”

Atypical gunshot injury to the neck with an unexpected nonlinear bullet trajectory: a case report and review of the literature

“…To our knowledge, this is the first report of a patient with a gunshot injury wherein the bullet almost transversely penetrated the entire neck, across its deep structures to the contralateral side of the shoulder, notably via a nonlinear path, traveling anterior to the left carotid sheath and posterior to the right carotid sheath without damaging any vital organs. Although various patients with atypical head and neck gunshot injuries who survived without fatal organ damage have been reported [10,[14][15][16][17][18][19][20][21][22], those with a true nonlinear bullet trajectory are limited to a few reports [10,15,21], where trajectories were implied to match the fascial planes with the least tissue resistance. Unlike our case, those reports suggested that the bullet penetrated the face from the masseteric region through the parapharyngeal and retropharyngeal spaces to the contralateral prestyloid space [10], or longitudinally passed through the unilateral side of the neck to the face from the caudal to the cranial side [15,21].…”

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

“…To our knowledge, this is the first report of a patient who survived a gunshot injury wherein the bullet traversed the entire neck across its deep structures to the contralateral side of the shoulder, notably via a nonlinear path, traveling anterior to the left carotid sheath and posterior to the right carotid sheath without damaging any vital organs. Although various patients with atypical head and neck gunshot injuries who survived without fatal organ damage have been reported [3][4][5][16][17][18][19][20][21][22], those with a true nonlinear bullet trajectory are limited to only a few reports [3][4][5], where trajectories were implied to match the fascial planes with the least tissue resistance. Unlike our case, those reports suggested that the bullet penetrated the face from the masseteric region through the parapharyngeal and retropharyngeal spaces to the contralateral prestyloid space [4], or longitudinally passed through the unilateral side of the neck to the face from the caudal to the cranial side [3,5].…”