MANAGEMENT OF GUN SHOT

WOUND OF ABDOMEN

Mr. S.A.H. a Somali national, aged 26 was

brought to ER at 00.10 AM/13/01/1432

with Gun shot(bullet) Injury at right gluteal

region.

He was shot by some one 2 hours before.

Patient complained of Pain right side of

abdomen/ No vomiting/No haematuria

Fully conscious and alert

Pulse:74, BP:140/80, R/R: 20, O2 Sat:

100%

LOCAL EXAMINATION: Entry wound Right

Gluteal Region, little oozing of blood from

the wound. NO EXIT WOUND.

CHEST: air entry present both side, equal,

no evidence of pneumo or Hemothorax.No

surgical emphysema.

ABDOMEN: Soft, no muscle guarding, no

distension, tenderness present over right

side of abdomen, Bullet was palpable in

right abdominal wall. Left half of the

abdomen completely normal. Normal

bowel sound.

No bleeding per Rectum or urethra.

CNS: fully conscious & alert, GCS:15/15,

no neurological deficit.

GUN SHOT WOUND RIGHT

GLUTEAL REGION/BULLET

LODGED IN ANT.ABDOMINAL

WALL . TO RULE OUT

INTRA ABDOMEN INJURY

(HOLLOW VISCUS INJURY)

XRAY CHEST ERECT: No air under

diaphragm

XRAY ABDOMEN: Bullet was seen 2 cms.

Above the Iliac crest (R). A hole about one

cm in diamater was seen in upper part of

iliac bone.

URGENT U/S ABDOMEN : No free fluid in

abdomen. No evidence of any solid viscus

injury.

Hb; 15.7, WBC: 8.8,

RBS: 128, CREA: 0.6

AST:67, ALT:25

ALP:50 BIL(T):0.9 (D):0.3

GTT:27 AMYL:63

The case was admitted , to be

under close observation and to do

double contrast CT abdomen.

TREATMENT ORDERED:

NPO/IV FLUIDS/IV

ANTIBIOTICS/REPEATED

EXAMINATION OF ABDOMEN.

Fully conscious alert

Mild pain abdomen at the site of bullet.

No vomitting/ No fever

Pulse:74, BP: 120/90, Temp: 37

Abdomen: Soft, No Distension, Tenderness

right side of abdomen at the site of

lodgment of bullet.No rigidity/No rebound

tenderness/Normal bowel sound.

Patient was given to drink about one litre of water mixed with gastrografin.

Patient was examined again at 12.40PM.Pain abdomen has increased /vomited

once/No feverVitals: NormalABDOMEN: Mild distension, Muscle guarding

present/ Tender/Rebound tenderness:?? Bowel sound +

DIAGNOSIS: PERITONISM/PROCEED FOR URGENT EXPLOR.LAPAROTOMY(AFTER CT ABDOMEN)

• PNEUMOPERITONEUM

• MILD AMOUNT OF FREE

FLUID

• HOLE IN ILIAC BONE(R)

• BULLET SEEN IN

ANT.ABD.WALL

TWO PERFORATIONS 1cm, each in sigmoid colon , piercing the posterior wall first ,then ant.wall of the colon. Bullet lodged in anterior abdominal wall. Little blood stained discharge in peritoneal cavity.

RETROPERITONEAL HEMATOMA.1CM TEAR IN POSTERIOR

PERITONEUM JUST 5MM BELOW CECUM.

Perforations were closed primarily in

two layers using 3/0 prolene.

Peritoneal toilet was done & Abdomen

was closed in layers after insertions of

two drains one in abdominal cavity

and one in pelvis.

Patient was put on IV antibiotics and

flagyl.

Patient started improving gradually.

Passed flatus on 15/01/1432, started oral

sips of water and fruit juice.

Remained on fluid diet till 18/01/32.

Started soft diet on 19th then normal diet.

All sutures were removed on 23/01/32.

Patient was discharged same day.

THANK YOU