Background: Gunshot injuries are always a challenging case, but is surgery always needed? Early assessment of the trajectory of bullet leads to an effective management plan. These cases require a multidisciplinary approach for a satisfactory outcome. Case Presentation: In this case, we present a 63-year-old male who was brought to our emergency department with a lower left flank gunshot wound. Imaging showed the location of the bullet in the abdominal wall musculature. Discussion: Atypical routes taken by bullets in firearm wounds can pose challenges in both surgical intervention and forensic medical diagnosis. Successful treatment necessitates a thorough clinical and radiological evaluation. Precise identification of the entry point, exit point, bullet’s path, and the degree of tissue damage is crucial for preparing for Bullet removal and predicting patient outcomes. However, not all individuals with gunshot injuries exhibit uncommon bullet paths. In certain instances, surgical intervention may even be unnecessary. Nevertheless, precise radiological evaluation remains essential in these complex situations. Conclusion: For effective management of gunshot wounds, a good clinical as well as paraclinical assessment is needed. A multidisciplinary approach remains the best way to improve prognosis.
References
[1]
Inchingolo, F., Tatullo, M., Marrelli, M., Inchingolo, A.D., Pinto, G., Inchingolo, A.M., et al. (2011) Short Report of an Unusual Ballistic Trauma. InternationalJournalofSurgeryCaseReports, 2, 272-274. https://doi.org/10.1016/j.ijscr.2011.08.009
[2]
Kakkar, A. and Kochhar, L.K. (2000) Missile Injuries of Face and Neck: Our Experience. IndianJournalofOtolaryngologyandHeadandNeckSurgery, 52, 334-339. https://doi.org/10.1007/bf02991472
[3]
Ongom, P.A., Kijjambu, S.C. and Jombwe, J. (2014) Atypical Gunshot Injury to the Right Side of the Face with the Bullet Lodged in the Carotid Sheath: A Case Report. JournalofMedicalCaseReports, 8, Article No. 29. https://doi.org/10.1186/1752-1947-8-29
Reiss, M., Reiss, G. and Pilling, E. (1998) Gunshot Injuries in the Head-Neck Area—Basic Principles, Diagnosis and Management. Praxis (Bern 1994), 87, 832-838.
[6]
Godhi, S., Mittal, G.S. and Kukreja, P. (2010) Gunshot Injury in the Neck with an Atypical Bullet Trajectory. JournalofMaxillofacialandOralSurgery, 10, 80-84. https://doi.org/10.1007/s12663-010-0124-6
[7]
Sari, A., Sari, A., Aksoy, A. and Basterzi, Y. (2006) Unexpected Route of a Bullet: From the Frontal Sinus to the Gastrointestinal Tract. AnnalsofPlasticSurgery, 57, 119-120. https://doi.org/10.1097/01.sap.0000218637.81908.07
[8]
Champion, H.R., Copes, W.S., Sacco, W.J., Lawnick, M.M., Keast, S.L. and Frey, C.F. (1990) The Major Trauma Outcome Study: Establishing National Norms for Trauma Care. TheJournalofTrauma: Injury, Infection, andCriticalCare, 30, 1356-1365. https://doi.org/10.1097/00005373-199011000-00008
[9]
Agha, R.A., Franchi, T., Sohrabi, C. and Mathew, G. (2020) The SCARE 2020 Guideline: Updating Consensus Surgical Case Report (SCARE) Guidelines. InternationalJournalofSurgery, 84, 226-230.
[10]
Reginelli, A., Russo, A., Maresca, D., Martiniello, C., Cappabianca, S. and Brunese, L. (2015) Imaging Assessment of Gunshot Wounds. SeminarsinUltrasound, CTandMRI, 36, 57-67. https://doi.org/10.1053/j.sult.2014.10.005
[11]
Angra, S.K., Padhy, S.C., Venkateswarlu, K. and Kalra, V.K. (1985) Bilateral Orbital Perforation. A Single Bullet Injury. Indian Journal of Ophthalmology, 33, 99-103.
[12]
Gürses, M.S., Akan, O., Eren, B., Durak, D., Türkmen, N. and Cetin, S. (2014) Medicolegal Aspects of Atypical Firearm Injuries: A Case Report. Soudni Lekarstvi, 59, 10-12.
[13]
Zeiler, J., Idell, S., Norwood, S. and Cook, A. (2020) Hemothorax: A Review of the Literature. ClinicalPulmonaryMedicine, 27, 1-12. https://doi.org/10.1097/cpm.0000000000000343
[14]
Rhee, P.M., Moore, E.E., Joseph, B., Tang, A., Pandit, V. and Vercruysse, G. (2016) Gunshot Wounds: A Review of Ballistics, Bullets, Weapons, and Myths. JournalofTraumaandAcuteCareSurgery, 80, 853-867. https://doi.org/10.1097/ta.0000000000001037
[15]
Anto, J., Kumar, A., Kumar, A., Anwer, M., Kumar, S. and Kumar, D. (2022) Gunshot Injury to the Chest Wall with an Unusual Bullet Trajectory: A Rare Case Report. InternationalJournalofSurgeryCaseReports, 96, Article ID: 107343. https://doi.org/10.1016/j.ijscr.2022.107343
[16]
Lorin de la Grandmaison, G. (2012) Blessures par projectile d’arme à feu: Aspects anatomopathologiques. AnnalesdePathologie, 32, 33-39. https://doi.org/10.1016/j.annpat.2011.10.005
[17]
Di Maio, V.J.M. (1999) Gunshot Wounds. Practical Aspects of Firearms, Ballistics, and Forensic Techniques. CRC Press.