scholarly journals Non-powder Lateral Penetrating Craniocerebral Gunshot Wound in a 10-Year-Old Girl: A Case Report

2020 ◽  
Author(s):  
Christopher Lauren ◽  
Donny Argie ◽  
Elric Brahm Malelak ◽  
Reza Mawardy ◽  
Samuel Edhi Suranta ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Gunshot Wound ◽  
Blood Clot ◽  
Signs And Symptoms ◽  
Gunshot Wounds ◽  
Low Velocity ◽  
Gun Barrel ◽  
Entrance Wound ◽  
Air Gun ◽  
The Right

Abstract Background: Non-powder lateral penetrating craniocerebral gunshot wounds (PCGW) is one of the lethal types of penetrating head injury. The mortality rate is higher in adults than in pediatric populations and influence by the clinical and radiologic findings as the important predictors for prognostication in patients with PGCW. Case Presentation: A 10-year-old girl presented with a gunshot wound to the head 1 day prior. She was accidentally shot by her brother with an air gun from approximately 2 feet from the gun barrel. She develops a loss of consciousness for 30 minutes and weakness over the left arm. In physical examination, the patient Glasgow Coma Scale (GCS) was E3 V5 M6, weakness on the left arm, and an entrance wound over the right temple without an exit wound. The skull X-ray show the pellet fragment and the computed tomography (CT) scan show the bullet track starting from the right frontotemporal towards the left parietooccipital region, damaging both hemispheres with associated intraventricular hemorrhage (IVH). She undergoes a craniotomy procedure to remove the bullet fragment, debridement of the necrotic tissue, and evacuating the blood clot the formed over the bullet track. The patient discharge after postoperative day 7 with good recovery of neurological function and good GCS and Glasgow Outcome Scale (GOS) score. After 6 months follow-up, neither a new deficit nor other signs and symptoms were developed.Conclusions: Non-powder PCGW can cause significant damage to the intracranial compartment, despite its low velocity. The mortality rate in pediatrics is lower than in adults population. The management mandated an urgent surgical procedure to remove any blood clot and debridement of any foreign bodies encountered. Such complications in short- or long term can be developed in any patients and should be treated expectantly.

scholarly journals Multiple Brain Abscesses by an Air Gun Shot: A Case Report

2021 ◽  
Author(s):  
Mohammad Jamali ◽  
Iman Ahrari ◽  
Keyvan Eghbal ◽  
Arash Saffarrian ◽  
Abbas Rakhsha ◽  
...  
Keyword(s):  
Brain Injury ◽  
Brain Injuries ◽  
Good Condition ◽  
Signs And Symptoms ◽  
Low Velocity ◽  
Penetrating Brain Injury ◽  
Air Gun ◽  
Gun Shot ◽  
Brain Abscesses ◽  
Air Gun Pellet

Abstract Introduction Low-velocity penetrating brain injury is not prevalent. In some conditions such as childhood, and with the penetration of a pellet in weak spots of skull, low-velocity penetrating brain injury is expected; however, high-velocity projectiles have also been reported as the cause of severe brain injuries. One of the complications of penetrating brain injury is infection, in which different types of microorganisms play a role. The Streptococcus genus is the leading cause of abscess formation in non-traumatic patients. Multiple brain abscesses are not common. Case Presentation A 10-year-old boy with penetrating brain injury caused by an air gun pellet, who developed signs and symptoms of high intracranial pressure 18 days after the trauma. After the imaging scans and the detection of multiple brain abscesses and severe brain edema, prompt surgical intervention was performed for all three lesions in a single operation. The culture of a pus specimen was positive for Streptococcus species, and, with adequate antibiotic therapy, the patient was discharged from the hospital in good condition. Conclusion Brain injury with air gun shot is not prevalent. The penetration of a low-velocity air gun pellet in weak points of the skull (such as the orbit, the squamous portion of the temporal bone, and the cranial suture), specially in children, can cause significant brain injuries.

scholarly journals Stage Reconstructive and Restorative Surgical Treatment of Gunshot Wounds of the Groin, Scrotum and Penis (Case Report)

Health of Man ◽  
2021 ◽  
pp. 85-90
Author(s):  
Serhii Golovko ◽  
Oleksandr Savytskiy ◽  
Oleksandr Netrebko ◽  
Yevhen Bidula ◽  
Volodymyr Bondarchuk
Keyword(s):  
Surgical Treatment ◽  
Gunshot Wound ◽  
Foreign Bodies ◽  
Soft Tissues ◽  
Gunshot Wounds ◽  
Soft Tissue Defects ◽  
Initial Stage ◽  
The Right ◽  
Upper Third ◽  
Tissue Defects

The frequency of external genital lesions in armed conflicts can reach up to 5%. The complexity of gunshot wounds is the presence of significant soft tissue defects, widespread necrosis around the wound, the possibility of progression in the hours and days after injury, the high probability of infection, and the presence of foreign bodies. The tactics of gunshot wounds are determined by the location, nature and extent of damage to soft tissues, organs, large vessels, nerves, bones and includes several stages. At the initial stage, bleeding is stopped, hematomas and foreign bodies are evacuated, non-viable tissues are removed, drainages are installed and skin defects are closed. The stage of reconstructive surgery can be started when the active wound process is over. In this report, we present a clinical case of a 22-year-old man who received a gunshot wound to the right groin, upper third of the right thigh, perineum and external genitalia in a combat zone of Operation Allied Forces, Ukraine. Bullet wound led to: damage to the skin and subcutaneous tissue in the right buttock, right groin, on the inner surface of the upper third of the thigh, penis (skin defect up to 1/3 of the circumference), scrotum, partial destruction of corpora cavernosa, m. iliopsoas and adductor muscles of the thigh, sphincter of the rectum, crushing of the right testicle. The wound was contaminated with earth and foreign bodies At the initial stage, the patient underwent: primary surgical treatment of a gunshot wound, suturing of cavernous bodies with sutures, fixation of the penis in the groin, removal of the right testicle, tamponade of the wound, sigmostomy (due to sphincter damage). Subsequently, the patient underwent regular surgical treatment of wounds, a vacuum suction system VAC was installed. After 7 months (upon completion of the healing process) suturing of the sigmostoma was performed. After 2 months, the penis and the scrotum were reconstructed. Preoperative examination (ultrasound of the penis with assessment of cavernous hemodynamics, MRI) revealed: post-traumatic scarring of the soft tissues of the right groin, inner surface of the right thigh, buttocks, right inguinal canal of the penis and scrotum, deformation of the cavernous cavity, normal indicators of cavernous blood circulation. In the early postoperative period (2 months after the intervention), the patient indicated satisfaction with the cosmetic and functional results, the preservation of morning erections, moderate discomfort in the penis during erection. Prosthetics of the right testicle are planned. The clinical case once again confirms the need for qualified surgical care during the first “golden” hour and subsequent phased treatment at a specialized level using the VAC therapy system in patients with gunshot wounds and large soft tissue defects. The experience of military medicine demonstrates the importance of involving specialists of various profiles in the treatment of combined gunshot wounds of the pelvis. An important stage of treatment in the wounded is plastic and reconstructive surgery in the long term, which is aimed at improving the functional, cosmetic and psychological results of treatment.

Practical Pathology of Gunshot Wounds

2006 ◽  
Vol 130 (9) ◽  
pp. 1283-1289 ◽  
Author(s):  
J. Scott Denton ◽  
Adrienne Segovia ◽  
James A. Filkins
Keyword(s):  
Law Enforcement ◽  
Justice System ◽  
Gunshot Wound ◽  
Gunshot Wounds ◽  
The United States ◽  
Medical Examiner ◽  
Manner Of Death ◽  
Entrance Wound ◽  
Practical Guidelines

Abstract Context.—Gunshot wounds are the most common cause of homicidal death in the United States. Analysis and interpretation of fatal gunshot wounds is an important and common practice among forensic pathologists. Additionally, for pathology residents, it is an integral aspect of their training during their rotations at medical examiner or coroner offices. Objective.—The correct interpretation of gunshot wounds by forensic pathologists not only provides valuable information that can assist law enforcement in their investigation but also is essential for the final determination of manner of death. Discussion of the practical, basic, and essential skills required to interpret gunshot wounds include distinguishing a classic entrance wound from an exit wound; recognizing atypical entrance and exit wounds; utilizing the features of soot and stippling patterns to differentiate among contact, close, and distant range gunshot wounds; understanding of the trauma produced by gunshot wounds; and understanding the importance of recovering and documenting/handling any projectiles recovered at autopsy. Data Sources.—This article reviews numerous standard forensic pathology textbooks and the pertinent literature to formulate practical guidelines to assist the pathologist in the performance of forensic autopsies and the investigation of gunshot wound fatalities. Conclusions.—Pathologists who perform investigations and autopsies to determine the cause and manner of death in gunshot wound cases must be aware of the implications, requirements, and pitfalls in interpretation of the injuries so that the examination fulfills its expectations to the community and the justice system.

scholarly journals Transmediastinal and Transcardiac Gunshot Wound with Hemodynamic Stability

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Leire Zarain Obrador ◽  
Yusef Mohamed Al-Lal ◽  
Jorge de Tomás Palacios ◽  
Iñaki Amunategui Prats ◽  
Fernando Turégano Fuentes
Keyword(s):  
Gunshot Wound ◽  
Median Sternotomy ◽  
Uneventful Recovery ◽  
Hemodynamic Stability ◽  
Group Iii ◽  
Entrance Wound ◽  
Group I ◽  
Breath Sounds ◽  
Chest X Ray ◽  
The Right

Cardiac injuries caused by knives and firearms are slightly increasing in our environment. We report the case of a 43-year-old male patient with a transmediastinal gunshot wound (TGSW) and a through-and-through cardiac wound who was hemodynamically stable upon his admission. He had an entrance wound below the left clavicle, with no exit wound, and decreased breath sounds in the right hemithorax. Chest X-ray showed the bullet in the right hemithorax and large right hemothorax. The ultrasound revealed pericardial effusion, and a chest tube produced 1500 cc. of blood, but he remained hemodynamically stable. Considering these findings, a median sternotomy was carried out, the through-and-through cardiac wounds were suture-repaired, lung laceration was sutured, and a pacemaker was placed in the right ventricle. The patient had uneventful recovery and was discharged home on the twelfth postoperative day. The management and prognosis of these patients are determined by the hemodynamic situation upon arrival to the Emergency Department (ED), as well as a prompt surgical repair if needed. Patients with a TGSW have been divided into three groups according to the SBP: group I, with SBP>100 mmHg; group II, with SBP 60–100 mmHg; and group III, with SBP<60 mmHg. The diagnostic workup and management should be tailored accordingly, and several series have confirmed high chances of success with conservative management when these patients are hemodynamically stable.

scholarly journals Bullet embolism in a case of homicide: Case report

2013 ◽  
Vol 141 (3-4) ◽  
pp. 242-246
Author(s):  
Vladimir Zivkovic ◽  
Fehim Jukovic ◽  
Slobodan Nikolic
Keyword(s):  
Femoral Artery ◽  
Gunshot Wound ◽  
Imaging Techniques ◽  
Rare Complication ◽  
Gunshot Wounds ◽  
The Body ◽  
Gunshot Injury ◽  
Thoracic Vertebrae ◽  
Injured Part ◽  
The Right

Introduction. Bullet embolism is a special form of embolism, where embolus is either a bullet or its fragment. Bullet penetrates through the injured part of the body into circulation and then travels to a distant part of the body, until it gets blocked in a vessel of the same diameter as the bullet. Case Outline. We are presenting a case of gunshot injury in a 26?year?old male, found unconscious on the passenger seat, with the gunshot injury of the right hand and hemithorax, who died two hours after admission to hospital. Post?mortem X?ray revealed the presence of a metallic foreign body - a bullet, in the level of the left femoral neck. The autopsy revealed entrance and exit gunshot wounds of the upper third of the right upper arm. There was a second entrance gunshot wound, and the bullet passed through the right hemithorax and the right lung, and then through the intervertebral disc between the eighth and ninth thoracic vertebrae, and also making a complete laceration of the wall of the thoracic aorta, in the right posterior semicircumference. The slightly deformed bul? let, caliber 7.65 mm, was found embedded in the lumen of the vessel at the bifurcation of the deep femoral artery from the left femoral artery. Conclusion. Bullet embolism is a rare complication of gunshot wounds. It should be suspected in any gunshot wound victim without an exit wound, or the lack of a missile in the bullet pathway, or if there are premortem signs or symptoms unexpected for the presumed pathway of the bullet, such as distant ischemia or infection. In these cases, some of postmortem imaging techniques should be used to save time in diagnosis, treatment and at autopsy.

scholarly journals Air gun wound: bihemispheric penetrating brain injury in a paediatric patient

2019 ◽  
Vol 5 (2) ◽  
pp. 20180070
Author(s):  
Andre Tjie Wijaya ◽  
I Made Dwijaputra Ayusta ◽  
I Wayan Niryana
Keyword(s):  
Brain Injury ◽  
Paediatric Population ◽  
Wound Ballistics ◽  
Low Velocity ◽  
Air Gun ◽  
Life Threatening ◽  
The Right ◽  
Contrast Ct ◽  
Occipital Lobes

Air guns are classified as low-velocity missiles and they usually considered safe and harmless. Despite that fact, air guns still can make serious or life-threatening injuries. Most of air gun injuries occur in paediatric population. A 2-year-old boy was shot in the forehead withan air gun accidentally. Skull radiography and non-contrast CT scan of the head were performed and showed penetrating bihemispheric brain injury from the left frontal to right occipital lobes at the level of the lateral ventricle with a metal-density foreign body at the right occipital. A projectile was successfully extracted via craniotomy, without complications. Air guns have the potential to cause fatal, life-threatening injury especially in children. Imaging is crucial for the evaluation of wound ballistics. Understanding about the mechanism of projectiles and wound ballistics is very helpful for radiologists to conceptualize these injuries when interpreting these cases. The role of radiology in ballistic wound cases is critical and important, both for clinical and forensic settings.

scholarly journals Transfixing abdominal gunshot wound without intra-abdominal lesions: A case report

2021 ◽  
Author(s):  
Axler Jean Paul ◽  
Nelle-Ange Mele ◽  
Ricardo Arens Jean Medeus ◽  
Weber Erne Shooles Raphael ◽  
Novensky Aurelien
Keyword(s):  
Abdominal Cavity ◽  
Psoas Muscle ◽  
Gunshot Wounds ◽  
Exploratory Laparotomy ◽  
Organ Damage ◽  
Entrance Wound ◽  
The Usa ◽  
The Right ◽  
Abdominal Lesions ◽  
Surgery Department

Abstract Background Abdominal gunshot trauma is considered the third leading cause of death in the USA and is responsible for more than 90% of deaths among young people aged 15 to 24. It leads to multi-systemic organ damage, shock, and infection. Case presentation A 20-year-old male alcohol and tobacco user with no relevant health history was admitted at Hôpital de l’Université d’Etat d’Haïti, in the emergency Surgery Department for an abdominal bullet wound. The initial clinical examination was unremarkable except for the presence of hemorrhagic lesions. A few hours later, the patient became diaphoretic, complained of abdominal pain. In view of his rapidly developing condition, he was prepared for the operating room. An exploratory laparotomy was performed, in which 100 cc of blood was found effusing into the abdominal cavity, without any intraperitoneal visceral damage. Systematic exploration showed retroperitoneal hematomas in zone II, where a wound in the psoas muscle was found on the posterior left, in the path of the exit wound of the projectile. Bone splinters were also present on the right in the path of the entrance wound, indicating a fracture of the iliac bone.Conclusion This case reminds us about the uncertain trajectory of projectiles in abdominal gunshot wounds and the possible lesions to which one is exposed, and that despite the apparent hemodynamic stability exploratory laparotomy still has its place where medical imaging technology is not available.

scholarly journals Meat Hook Injury Leading to Brain Abscess: A Rare Occurrence

2021 ◽  
Author(s):  
Batuk Diyora ◽  
Gagan Dhall ◽  
Mehool Patel ◽  
Mazharkhan Mulla ◽  
Nilesh More ◽  
...  
Keyword(s):  
Brain Abscess ◽  
Signs And Symptoms ◽  
Penetrating Injury ◽  
Perilesional Edema ◽  
Delayed Complications ◽  
The Right ◽  
Time Of Presentation ◽  
Local Examination ◽  
Abscess Wall ◽  
Primary Injury

AbstractTransorbital orbitofrontal penetrating injury by a nonmissile object is uncommon. The presentation of this injury varies. This injury can be easily missed during the initial clinical presentation, because the foreign body is sometimes not visible on local examination, the wound on the orbital skin is small, and very subtle signs are present. The patient can present with delayed complications of the primary injury. Our patient was a 33-year-old male who presented with an orbitofrontal injury with a meat hook. He had minor symptoms at the time of presentation, which were overlooked. Three weeks later, he developed signs and symptoms of raised intracranial pressure (ICP). Brain imaging revealed a peripheral rim of contrast-enhancing mass lesion in the right frontal lobe, extending into the right orbit with perilesional edema suggestive of posttraumatic brain abscess. Via right frontal craniotomy, pus was drained out and abscess wall was excised. The patient made good clinical recovery. A higher index of suspicion and sound knowledge of occult penetrating injury patterns is required in the cases of orbital injuries. Appropriate radiological imaging can lead to an earlier and accurate diagnosis, and can prevent its delayed sequela like brain abscess.

scholarly journals An Unusual Presentation of Pyelonephritis: Is It COVID-19 Related?

2021 ◽  
Author(s):  
L. J. van ‘t Hof ◽  
L. Pellikaan ◽  
D. Soonawala ◽  
H. Roshani
Keyword(s):  
Late Onset ◽  
Blood Clot ◽  
Time Frame ◽  
Venous Occlusion ◽  
Late Complications ◽  
Organ Injury ◽  
Vein Thrombosis ◽  
Lower Back ◽  
The Right ◽  
Renal Infection

AbstractIn severe cases of COVID-19, late complications such as coagulopathy and organ injury are increasingly described. In milder cases of the disease, the exact time frame and causal path of late-onset complications have not yet been determined. Although direct and indirect renal injury by SARS-CoV-2 has been confirmed, hemorrhagic renal infection or coagulative problems in the urinary tract have not yet been described. This case report describes a 35-year-old female without relevant medical history who, five days after having recovered from infection with SARS-CoV-2, had an unusual course of acute pyelonephritis of the right kidney and persistent fever under targeted antibiotic treatment. A hemorrhagic ureteral obstruction and severe swollen renal parenchyma preceded the onset of fever and was related to the developing pyelonephritis. Sudden thrombotic venous occlusion in the right eye appeared during admission. Symmetrical paresthesia in the limbs in combination with severe lower back pain and gastro-intestinal complaints also occurred and remained unexplained despite thorough investigation. We present the unusual combination of culture-confirmed bacterial hemorrhagic pyelonephritis with a blood clot in the proximal right ureter, complicated by retinal vein thrombosis, in a patient who had recovered from SARS-CoV-2-infection five days before presentation. The case is suspect of a COVID-19-related etiology.

Features of the development of traumatic pancreatitis with gunshot wounds to the abdomen

2021 ◽  
Vol 23 (1) ◽  
pp. 101-108
Author(s):  
Nikita I. Myasnikov ◽  
Vyacheslav V. Panov ◽  
Mariyama R. Ba ◽  
Igor Y. Kim ◽  
Kazibek B. Chakalsky ◽  
...  
Keyword(s):  
High Probability ◽  
Gunshot Wound ◽  
Gunshot Wounds ◽  
Pancreatic Injury ◽  
Lateral Impact ◽  
Timely Manner ◽  
Military Conflict ◽  
Diagnostic Potential ◽  
Traumatic Pancreatitis ◽  
Diagnostic Capabilities

The features of the development of traumatic pancreatitis in gunshot wounds of the abdomen, which present difficulties in timely diagnosis, are considered, hypotheses are formulated for studying the problem. Two clinical cases of developing traumatic pancreatitis against the background of a gunshot wound to the abdomen with indirect damage to the pancreas are presented. Without taking into account the peculiarities of the formation of the wound canal relative to the organs of the abdomen, in conditions of limited diagnostic potential, there is a high probability of late diagnosis of traumatic pancreatitis, especially in indirect damage. Injuries to the organs of the upper half of the abdomen can be risk factors for indirect damage to the pancreas due to the effect of lateral impact energy and the formation of a temporary pulsating cavity. In general, the management of such wounded in a surgical hospital with limited diagnostic capabilities or with stage treatment in a local military conflict requires the surgeon to know the peculiarities of the course of traumatic pancreatitis, which make it possible to prevent the development of complications in a timely manner. The development of traumatic pancreatitis in penetrating gunshot wounds to the abdomen is not always a consequence of direct pancreatic injury. This circumstance must always be taken into account during a diagnostic laparotomy.

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