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Pattern of civilian gunshot injuries in Irrua, Nigeria
JE Onuminya, E Ohwowhiagbese
South African Journal of Surgery , 2005,
Abstract: This retrospective review of 76 patients with gunshot wounds was undertaken to evaluate the pattern and outcome of civilian gunshot injuries in our region. The extremities were the most commonly affected site (51.5% of all gunshot wounds). Gunshot injuries were most common among young males in the third decade of life, and armed robbery was the cause of gunshot trauma in 69.7% of cases. Time from injury to arrival at hospital was less than 6 hours in 64.4% of cases. Wound exploration and debridement were the mode of treatment in the majority of cases. Hypovolaemia resulting from acute haemorrhage accounted for 52.9% of complications. The mortality rate was 5.3%. It is pertinent to observe that inefficient firearm control is a major factor contributing to civilian gunshot injuries in our region. In addition, high rates of unemployment and poverty in our society may be contributing to the increasing incidence of youth restiveness, armed robbery and associated gunshot injuries. Strong government legislation is required to provide adequate security for the teeming civilian population. The national government should embark on a poverty eradication strategy and engage the youth in gainful employment to reduce the incidence of youth restiveness, armed robbery and firearm-related violence. South African Journal of Surgery Vol. 43 (4) 2005: pp. 170-172
Computed Tomography (CT) in civilian gunshot head injuries in Ibadan
MO Obajimi, MT Shokunbi, AA Malomo, AM Agunloye
West African Journal of Medicine , 2004,
Abstract: Background: There is data on civilian gunshot injuries in Nigerians. The purpose of the study is to describe the Computed Tomography findings of civilian gunshot injuries (GSI) to the head in Ibadan, Nigeria. Method: This is a retrospective study of Computed Tomography (CT) films and clinical records of 28 consecutive civilian gunshot injuries to the head from 1996 to 1999. Results: The gunshot injuries to the head were mostly armed robbery related. Though there was a steady annual increase of civilian gunshot injuries during the study period, a low CT Scan frequency (0.61%) was recorded. The following CT findings were present in all the patients; bullet fragments, intraparenchymal haemorrhage, vault fractures and soft tissue swelling. The resting position of the bullets showed a predilection for the parietal lobe (32.1%) and the most common fracture site was also the parietal bone (42.8%). Conclusion: CT findings simplified the management of civilian gunshot injuries to the head in the patients studied by demonstrating the exact pathology sequel to the injury. Despite important constraints, CT remains a cost effective means of managing GSI to the head. Key Words: Gunshot, Head injury, Computed Tomography Résumé II s'agit des donnees sur des civils atteints des blessures par balle au Nigéria. L'objet de cet étude est de décrire les résultats de la tomographie Calculée des civils atteints de blessures par balle dans la tête à Ibadan. Nigeria. Méthodes: C'est une étude rétrospective de la Tomographie Claculée (CT) cinema et dossiers cliniques de 28 civils consécutifs atteints des blessures par balle dans la tête de 1996 a 1999. Resultats: Les blessures par belle dans la tête étaient principalement liées au vol à main armée. Quoiqu'il ait une augumentation continue annuelle des cas des blessures par balle chez dez civils pendant la periode de cet étude, on a noté une frequence de 0, 61% de CT Scan tres bas. Les résultats de CT suivants ont été remarqués chez tous les patients:- morceau de balle, hémorragie intraparenchymal, fractures de saut et tuméfaction de tissu mou, lieu d'abri des balles a indiqué une prédilection pour le lobe pariétal (32, 1%) et le siege le plus concerné de la fracture également l'os pariétal (42, 8%). Conclusion: Les résultats à travers le CT ont simplifie la prise en charge des blessures par balle dans les têtes des civils chez des patients étudiés tout en donnant une demonstration pratique du fonctionnement de la pathologie exacte suite à la blessure. En dépit des restriction/constraints considerables, CT demeure un moyen rentable de la prise en charge de GSI dans la tête. West African Journal of Medicine Vol.23(1) 2004: 58-61
Penetrating head trauma following gunshot in a nonneurosurgical trauma centre: a case report
I.I Onah, A Onah
Nigerian Journal of Clinical Practice , 2010,
Abstract: With the dearth of trained neurosurgeons in sub-Saharan Africa and increasing civilian violence, penetrating head trauma occasionally present to other clinicians for management. The National Orthopaedic Hospital, Enugu is a non-neurologic trauma centre having the south-east, south-south geopolitical zones, and parts of Benue and Kogi states as the catchments area. A retrospective report from the case note of a patient with infratentorial brain injury from a gunshot is presented. He was treated conservatively and had a satisfactory outcome. The follow up is for four years. Adequate resuscitation and monitoring is crucial in successfully managing head injuries.
Epidemiology of gunshot injuries in Kano, Nigeria
AZ Mohammed, ST Edino, O Ochicha, AB Umar
Nigerian Journal of Surgical Research , 2005,
Abstract: Background: The incidence of civilian gunshot injuries has been reported to be on the increase globally. This study was undertaken to determine the epidemiology of gunshot injuries in Kano, Northern Nigeria. Patients and Methods: A retrospective analysis of patients with gunshot injuries seen at five major government hospitals in Kano metropolis over a four year period (1999-2002). Results: There were 224 cases, with males out-numbering females by a ratio of 27:1. Eighty -one point three percent of patients were aged between 20 and 44 years. The most commonly injured body regions were the lower limbs (31.6%), chest (15.6%), upper limbs (9.4%) and head (9.0%). A fatal outcome was recorded in 12.5% of cases. Most injuries occurred among traders, students, farmers and security agents, and armed robbery attacks and civil conflicts were the aetiological factors in majority of cases. Conclusion: Gunshot injuries are a major cause of morbidity among adult men in Kano. Addressing the root causes of violence such as poverty, unemployment, and substance abuse will reduce the incidence of gunshot injuries in our society.
Civilian popliteal artery injuries
MA Banderker, PH Navsaria, S Edu, W Bekker, AJ Nicol, N Naidoo
South African Journal of Surgery , 2012,
Abstract: Background. Civilian popliteal artery injuries are associated with significant amputation rates. Aim. The aim of this study was to identify factors associated with limb loss in patients with popliteal artery injuries. Patients and methods. We performed a retrospective chart review of prospectively collected data on patients with popliteal artery injuries presenting to the Trauma Centre at Groote Schuur Hospital, Cape Town, from 1 January 1999 to 31 December 2008. Demographic data, mechanism of injury, haemodynamic status, limb viability, special investigations, associated injuries, ischaemic time, surgical treatment and amputation rates were analysed. Results. One hundred and thirty-six patients with popliteal artery injuries were identified. Penetrating and blunt trauma accounted for 81 (59.6%) and 55 (40.4%) injuries, respectively. Associated injuries included fractures in 66 patients (48.6%), knee dislocations in 29 (21.3%) and popliteal vein injuries in 59 (43.4%). Fifty-seven patients (41.9%) presented with a compartment syndrome. Arterial injuries were treated with reversed vein grafting in 68 patients, primary anastomosis in 33, prosthetic graft insertion in 11, and primary amputation in 7. Thirty-two patients underwent delayed amputation, giving an overall amputation rate of 37.5%. A delay of more than 7 hours of ischaemic time between injury and definitive repair (p=0.0236) and the presence of a compartment syndrome (p=0.003) were significantly associated with an increased amputation rate. Conclusion. The most significant factors associated with the high amputation rate of 37.5% were an ischaemic time longer than 7 hours, and the presence of a compartment syndrome.
Arterial injuries in civilian practice in Lagos, Nigeria
MO Thomas, SO Giwa, TO Adekoya-Cole
Nigerian Journal of Clinical Practice , 2005,
Abstract: Objective: This is a retrospective study of patients managed at the Lagos University Teaching Hospital for peripheral arterial injuries from January 1995 to April 2003. The aim was to study the pattern of peripheral arterial injuries in Lagos, Nigeria and to look at the outcome of management and see what improvements could be made in future. Method: Data was collated from case notes of patients, operation register in theatre and admission and discharge books from the surgical wards and the data bank of consultants involved in patients' management. Result: Forty-one patients, 37 males and 4 females, were treated within the study period (M:F ratio of 9:1). Twenty three patients (56.1%) suffered gunshot injuries during armed robbery attacks while 9 patients (22.0%) had stab injuries in civilian violence. Twenty-one patients (3 with gunshot injuries and 18 non gunshot penetrating injuries) were managed by direct suturing of vessels. Eight patients had prosthetic graft interposition while 2 patients had reversed saphenous vein grafts. Two patients had the superficial branches of their radial arteries tied up at the wrist. Conclusion: Gun shot injuries from armed robbery attack was the commonest cause of peripheral arterial injuries in this environment during the period of study.
Gunshot injuries: A Tanzanian experience in a Teaching hospital in the Lake Zone
PL Chalya, M Mchembe, JM Gilyoma, JB Mabula, ES Kanumba
East and Central African Journal of Surgery , 2011,
Abstract: Background: Gunshot injuries (GSIs) are a unique form of trauma that are on increase all over the world and contribute significantly to high morbidity and mortality. The aim of this study was to evaluate the incidence, injury characteristics and treatment outcome of GSI in our local setting and to suggest preventive strategies as well as treatment protocols. Methods: This was a combined retrospective and prospective study of GSI patients who were managed at Bugando Medical Centre from April 2006 to March 2010. Data were collected from patients’ records and operation theatre registers and analyzed using SPSS software version 11.5. Results: A total of 84 GSI patients were studied. Males outnumbered females by a ratio of 15.8:1. Their mean age was 29.82 ± 16.26 years. The modal age group was 21-30 years. The majority of GSIs (84.6%) were caused by armed robbery attacks and low-velocity injuries were the majority (61.9%). Most injuries were in the limbs (64.1%) and the majority of gunshot wounds were punctured wounds (56.5%) and lacerations (23.9%). Soft tissue injuries (100%) and fractures (45.7%) were the most common type of injuries sustained. The majority of patients (85.7%) were treated surgically. Wound exploration and debridement were the mode of treatment in the majority of cases. Wound infection (49.1%) and complications of fractures (21.1%) were the most common complications. The mean duration of hospital stay was 34.2 days (1 – 186 days). Mortality rate was 8.3%. Conclusion: Gunshot injuries are a major cause of morbidity and mortality among young adult males in our setting. Addressing the root causes of violence such as poverty, unemployment, and substance abuse will reduce the incidence of gunshot injuries in our environment.
Penetrating Bladder Trauma: A High Risk Factor for Associated Rectal Injury  [PDF]
B. M. Pereira,L. O. Reis,T. R. Calderan,C. C. de Campos,G. P. Fraga
Advances in Urology , 2014, DOI: 10.1155/2014/386280
Abstract: Demographics and mechanisms were analyzed in prospectively maintained level one trauma center database 1990–2012. Among 2,693 trauma laparotomies, 113 (4.1%) presented bladder lesions; 51.3% with penetrating injuries ( ); 41.3% ( ) with rectal injuries, males corresponding to 95.8%, mean age 29.8 years; 79.1% with gunshot wounds and 20.9% with impalement; 91.6% arriving the emergence room awake (Glasgow 14-15), hemodynamically stable (average systolic blood pressure 119.5?mmHg); 95.8% with macroscopic hematuria; and 100% with penetrating stigmata. Physical exam was not sensitive for rectal injuries, showing only 25% positivity in patients. While 60% of intraperitoneal bladder injuries were surgically repaired, extraperitoneal ones were mainly repaired using Foley catheter alone (87.6%). Rectal injuries, intraperitoneal in 66.6% of the cases and AAST-OIS grade II in 45.8%, were treated with primary suture plus protective colostomy; 8.3% were sigmoid injuries, and 70.8% of all injuries had a minimum stool spillage. Mean injury severity score was 19; mean length of stay 10 days; 20% of complications with no death. Concomitant rectal injuries were not a determinant prognosis factor. Penetrating bladder injuries are highly associated with rectal injuries (41.3%). Heme-negative rectal examination should not preclude proctoscopy and eventually rectal surgical exploration (only 25% sensitivity). 1. Introduction Penetrating trauma implies that either a gunshot wound or a stab wound has entered the abdominal cavity. The gunshot wound is associated with high-energy transfer and the extent of intra-abdominal injuries is difficult to predict. Both the path of the missile and secondary missiles are unpredictable, as well as bone fragments or fragments of the bullet that can inflict other injuries. The velocity of assault rifles and hunting firearms is much higher than that of civilian handguns and therefore has a much higher energy transfer to the tissue. Stab wound injuries can be inflicted by many objects other than knives, including knitting needles, garden forks, fence railing, wire, pencils, and pipes. They are usually more predictable with regard to injured organs. Nevertheless, a high index of suspicion must be maintained to avoid missing occult injuries [1]. Penetrating bladder injuries may be caused by injuries to the abdomen, thigh, or buttock just as rectal injuries. Any penetrating wound that may have injured the rectum should be fully evaluated to avoid severe complications [2]. This study aimed to report authors’ experiences with associated
FACTORS EFFECTING MORTALITY IN PATIENTS WITH GUNSHOT INJURIES
Sava? Eri?,Murat Orak,Beh?et Al,Cahfer Gülo?lu
Marmara Medical Journal , 2009,
Abstract: Objective: We planned this study in order to determine the factors affecting mortality in patients with gunshot injuries in more than one organ.Methods: We retrospectively reviewed the hospital records of 714 patients admitted to the Emergency Department of Dicle University, between January 2000 and December 2004. The factors that we considered would affect mortality such as age, sex, attempts suicide, long barreled gun injuries, pellet injuries, contact/near contact shot, delayed admission time, presence of serious anemia and shock during admission, more than four entrance wounds, injury areas, serious cranial, thorax and abdominal injuries, vascular injuries in the extremity, administration of multiple transfusion, and trauma scores as GKS, RTS, PATI were analyzed.Results: As a result of unvaried statistical analyses, we determined that suicide attempts (p=0.001), presence of serious anemia (p=0.001) and shock (p=0.001) during admission, presence of serious cranial (p=0.001), thorax (p=0.001) and abdominal (p=0.001) injury, femoral artery injury (p=0.001), multiple blood transfusion (p=0.009), , GKS 0-7, GKS 8-12 (p=0.001) and low RTS (p=0.001)were significant factors affecting mortality.Conclusion: Multivariate analysis showed that serious anemia during admission, serious cranial injury, serious abdominal injury and low RTS were independently significant in predicting mortality (p<0.05).
A decade of civilian vascular trauma in Kosovo  [cached]
Jaha Luan,Andreevska Tatjana,Rudari Hajriz,Ademi Bekim
World Journal of Emergency Surgery , 2012, DOI: 10.1186/1749-7922-7-24
Abstract: Purpose We sought to analyze the results of arterial injury management in a busy metropolitan vascular unit and risk factors associated with mortality and morbidity. Patients and methods We analyzed 120 patient with arterial injury treated between year 2000 and 2010 at the University Clinical Center of Kosovo. Seven of these years were prospective and three retrospective study. Results The mechanism of arterial injury was stabbing 46.66%, gunshot wounds in 31.66%, blunt in 13.33%, and landmine in 8.33%. The most frequently injured vessel was the superficial femoral artery (25%), followed by the brachial artery (20.9%), crural arteries (13.1%), forearm arteries (14.3%), iliac arteries (7.5%), abdominal aorta (3.3%), common femoral artery (3.3%) and popliteal artery (3.3%). Associated injuries including bone, nerve and remote injury (affecting the head, chest, or abdomen) were present in 24.2% of patients. The decision to operate was made based on the presence of “hard signs” of vascular trauma. Arterial reconstruction was performed in 90.8% of patients, 5.8% of patients underwent primary amputation and 3.2% died on the operation table. Overall survival rate was 95.8%. Conclusion Injuries to the arteries are associated with significant mortality and morbidity. Mechanism of injury (blunt, gunshot, landmine or stub), hemodynamic stability at the admission, localization of injury, time from injury to flow restitution, associated injuries to the structures in the region and remote organs are critical factors influencing outcome.
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