Spontaneous migration of a falling bullet in the cerebellum reveals the importance of intraoperative skull X-ray

Cranial gunshot wounds (CGSWs) are the most lethal types of the cranial traumas and they are usually mortal. Falling bullets or gravitational bullets are the ones that move under the effect of the gravity force after the muzzle force diminished. CGSWs constitute a major clinical challenge for neurosurgeons dealing with trauma in both the military and civil experience. We report the case of a 21-year-old man with a falling bullet wound to the head. The decision of surgical treatment of a bullet injury is difficult if it is in close proximity to vital structures; removal of the bullet may cause significant neurological damage; however, migration can lead to a worsening of the neurological status of the patient. Before surgical removal of any intracranial bullet, as valuable information, it is recommended that a plain skull X-ray be obtained after final positioning of the head.

A Bullet Injury to the Liver Complicated by Biliary Broncho Pleural Fistula and IVC Thrombosis: Case Presentation and Review for Management Guidelines

This is a case report of a 20-year-old male who presented to our hospital after sustaining a gunshot to the left upper abdominal quadrant with an exit right below the right scapula. On investigation, he was found to have a large right sided hemothorax and an extensive laceration in the liver. A right chest tube drain was inserted, initially drained blood and days later started draining bile. Consequently, the patient started coughing up bile and diagnosis of a biliary-broncho-pleural fistula was made. ERCP with sphincterotomy and stenting of a left hepatic duct injury was subsequently performed. The patient also developed an IVC thrombus that was discovered incidentally on follow up imaging and was treated with anticoagulation

The role of strict patient-positioning during nursing in the management of intracerebral migration of gravitational bullet injury

The intracranial migration of bullet was described in literature since Cushing time and the First World War [1]. The literature is still away from delivering a clear guideline and constitutes more of case reports rather than comprehensive well-designed studies [2-13], this mostly due to the variability and diversity in the presentation and management of such cases. The migration of bullet can be a sequel of any type of penetrating injury to the skull [14]. Intracranial migration after gravitational (falling) bullet injury is a unique type of injury that constitutes of significant human and material losses with differences in biomechanics and structural brain changes after the insult especially regarding the velocity of impact and the degree of yaw for the intracranially settled bullet [15]. The gravitational bullets injuries are considered by the international disease classification system as celebratory firing, that is quite common and is part of the traditional happy (marriage) or funeral event in the middle east in general and in rural areas of Iraq in particular, and also reported in some areas around the world (South America, North Africa, and middle of Asia) [15,16].

Injury patterns and causes of death in 953 patients with penetrating abdominal war wounds in a civilian independent non-governmental organization hospital in Lashkargah, Afghanistan

Background Management of penetrating abdominal war injuries centers upon triage, echeloned care, and damage control. A civilian hospital based in a war zone can rarely rely upon these principles because it normally has limited resources and lacks rapid medical evacuation. We designed this study to describe organ injury patterns and factors related to mortality in patients with penetrating abdominal war injuries in a civilian hospital in an active war zone in Afghanistan, examine how these findings differ from those in a typical military setting, and evaluate how they might improve patients’ care. Methods We reviewed the records of all patients admitted at the Lashkargah “Emergency” hospital with penetrating abdominal injuries treated from January 2006 to December 2016. Demographic and clinical data were recorded; univariate and multivariate analyses were used to identify variables significantly associated with death. Results We treated 953 patients for penetrating abdominal injury. The population was mainly civilian (12.1% women and 21% under 14). Mean age was 23 years, and patients with blast injuries were younger than in the other groups. The mechanism of injury was bullet injury in 589 patients, shell injury in 246, stab wound in 97, and mine injury in 21. The most frequent abdominal lesion was small bowel injury (46.3%). Small and large bowel injuries were the most frequent in the blast groups, stomach injury in stab wounds. Overall mortality was 12.8%. Variables significantly associated with death were age > 34 years, mine and bullet injury, length of stay, time since injury > 5 h, injury severity score > 17, and associated injuries. Conclusions Epidemiology and patterns of injury in a civilian hospital differ from those reported in a typical military setting. Our population is mainly civilian with a significant number of women and patients under 14 years. BI are more frequent than blast injuries, and gastrointestinal injuries are more common than injuries to solid organs. In this austere setting, surgeons need to acquire a wide range of skills from multiple surgical specialties. These findings might guide trauma and general surgeons treating penetrating abdominal war wounds to achieve better care and outcome.

A Case of Bullet Injury of Spine

Available with full text.Nepal Journal of Neuroscience, Volume 14, Number 1, 2017, Page: 25-27