Multiple thoracoabdominal gunshot wounds with complicated trajectories

Abstract

A 41-year-old man was shot three times with a custom-made handgun. There were six small round wounds on the surface from two bullets that went into the body and one bullet found in a wall behind the victim at the scene. The gunshot wound in the left supraclavicular region bled massively. He was transferred to our hospital and soon fell into shock. A chest radiogram showed right hemothorax. Resuscitation and blood transfusion were started, and right thoracic drainage was immediately undertaken. The left subclavicular region was incised, and bleeding from the left subclavian vein stopped. Right thoracotomy was done, and bleeding from the lung was controlled. Laparotomy was needed to look for the missing trajectory. Speculation regarding trajectories of bullets in patients with multiple thoracoabdominal gunshot wounds is difficult, and an emergent operation is often needed to control bleeding or to evaluate possible organ injury.

Biphasic clinical characteristics of mild to moderate chest trauma according to age

“…This may be because the public emergency service workers send patients with less severe injuries to our hospital and send patients with more severe injuries to another larger institution near by. 7 In the literature, the presence of rib fractures has been reported to be an important factor in predicting a poor outcome; however, we could fi nd no supportive statistical evidence for this in our study. 2,3 The cause of the in-hospital death of two patients in our study was not directly associated with chest trauma.…”

Atypical Trajectory of a Thoracoabdominal Gunshot Injury without Penetration

“…The trajectory depends on the following: the status of the organs; the size, shape, and initial speed of the bullet; and the distance and direction of the shooting. Furthermore, the posture of a victim at the time of the injury is important [1]. Transition trajectories are irregular and variable, and sometimes no relationship is established between the entrance and exit sites of the bullet in injuries by civilian weapons, such as pistols and shotguns [4].…”

“…However, in such patients, it can be difficult to identify the trajectory of the bullet. Additionally, a thoracoabdominal gunshot injury is sometimes critical due to the difficulty in determination of the damaged organs, and instant occurrence of massive bleeding [1]. Helical computed tomography (CT) is useful for determining a trajectory; however, with multiple trajectories, the accurate diagnosis is difficult.…”

“…Helical computed tomography (CT) is useful for determining a trajectory; however, with multiple trajectories, the accurate diagnosis is difficult. Therefore, gathering detailed information at the crime scene is important for the correct identification of multiple trajectories [1,2].…”

Determining Trajectory to Predict Injury: The Use of X-Ray During Resuscitation in Gunshot Wounds

“…The posture of the patient at the time of the shooting must also be considered. 4 Trajectories are irregular and variable and sometimes no relationship is established between the entrance and exit sites of the bullet in injuries by civilian weapons. 5 Essentially, simply connecting two wounds with a straight line may not result in an accurate assessment of potential internal injuries.…”