Journal of Trauma and Injury

Case Reports

Penetrating right ventricular injury following a single gunshot to the left flank in Iraq: a case report: Zryan Salar Majeed, Yad N. Othman, Razhan K. Ali; J Trauma Inj. 2023;36(3):253-257. Published online April 19, 2023; DOI: https://doi.org/10.20408/jti.2022.0073

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Abstract PDF: A century ago, cardiac injuries usually resulted in death. However, despite all the advances in medicine, these injuries still have high mortality and morbidity rates. In the present case, we describe a patient with a bullet injury to the right ventricle who survived at our hospital despite the limitations of our center with regard to modalities and equipment. A 30-year-old man was brought to our emergency department with a bullet wound to his left flank. He was hemodynamically unstable. After only 8 minutes in the hospital and without further investigations he was rushed to the operating room. During laparotomy, a clot was visible in the left diaphragm, which dislodged and caused extensive bleeding. The decision was made to perform a sternotomy in the absence of a sternal saw. An oblique 8-cm injury to the right ventricle was discovered following rapid exploration. It was repaired without the need for cardiopulmonary bypass surgery. After a few days in the hospital, the patient was discharged home. In the event of a penetrating cardiac injury, rapid decision-making is crucial for survival. Whenever possible, the patient should be transferred to the operating room, as emergency department thoracotomies are associated with a high mortality rate.; Summary

Experience and successful treatment of craniocerebral gunshot injury at a regional trauma center in Korea: a case report and literature review: Mahnjeong Ha, Seunghan Yu, Jung Hwan Lee, Byung Chul Kim, Hyuk Jin Choi; J Trauma Inj. 2022;35(4):277-281. Published online November 22, 2022; DOI: https://doi.org/10.20408/jti.2022.0057

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Abstract PDF: Craniocerebral gunshot injuries is gradually increasing in the civilian population with a worse prognosis than closed head trauma. We experienced a case of craniocerebral gunshot injury which a bullet penetrating from the submandibular area into the clivus of a patient. The patient did not show any symptom. However, serial laboratory findings showed an increase in blood lead level. We removed foreign bodies without any problems using an endoscopic transnasal transclival approach. Due to the extremely low frequency, guidelines for definitive management of gunshot injuries have not been presented in Korea yet. We introduce our surgical experience of a craniocerebral gunshot injury with an unusual approach for removing intracranial foreign bodies.; Summary

Management of a Retained Bullet in the Corpora Cavernosa after a Civilian Gunshot Injury: A Rare Scenario: Ali Abdel Raheem, Ibrahim Alowidah, Mohamed Almousa, Mohamed Alturki; J Trauma Inj. 2020;33(4):275-278. Published online June 2, 2020; DOI: https://doi.org/10.20408/jti.2020.007

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Abstract PDF

A 24-year-old man presented to King Saud Medical City emergency department with a retained bullet in his penis following a civilian exchange of gunfire. After an initial assessment, the patient was taken to the operating room. Penile exploration was performed, the bullet was extracted successfully, and the corpora cavernosa were repaired properly. A 6-week follow-up showed full healing with preservation of erectile function. Immediate surgical intervention is mandatory as the primary treatment for penile gunshot injury to ensure proper anatomical and functional recovery.

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Citations

Citations to this article as recorded by

Retained Bullet in the Penis
Morgan Eudy, Natalie Nowak
Cureus.2021;[Epub] CrossRef

Experience of Penetrating Gunshot Wound on Head in Korea: Hong Rye Kim, Seung Je Go, Young Hoon Sul, Jin Bong Ye, Jin Young Lee, Jung Hee Choi, Seoung Myoung Choi, Yook Kim, Su Young Yoon; J Trauma Inj. 2018;31(2):82-86. Published online August 31, 2018; DOI: https://doi.org/10.20408/jti.2018.31.2.82

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Craniocerebral gunshot injuries (CGIs) are extremely seldom happened in Korea because possession of individual firearm is illegal. So, CGIs are rarely encountered by Korean neurosurgeons or Korean trauma surgeons, though in other developing countries or Unites states of America their cases are indefatigably increasing. Management goal should focus on early aggressive, vigorous resuscitation. The treatments consist of immediate life salvage through correction of coagulopathy, intracranial decompression, prevention of infection and preservation of nervous tissue. There have been few studies involving penetrating CGIs in Korea. Here we present a case of penetrating gunshot wound in Korea. We present a 58-year-old man who was unintentionally shot by his colleague with a shotgun. The patients underwent computed tomography (CT) for assessment of intracranial injury. The bullet passed through the left parietal bone and right lateral ventricle and exited through the posterior auricular right temporal bone. After CT scan, he arrested and the cardiopulmonary resuscitation was conducted immediately. But we were unable to resuscitate him. This case report underscores the importance of the initial clinical exam and CT studies along with adequate resuscitation to make the appropriate management decision. Physicians should be familiar with the various injury patterns and imaging findings which are poor prognostic indicators.

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Citations to this article as recorded by

Civilian penetrating traumatic brain injury: A 5-year single-center experience
Omid Yousefi, Pouria Azami, Roham Borazjani, Amin Niakan, Mahnaz Yadollahi, Hosseinali Khalili
Surgical Neurology International.2023; 14: 28. CrossRef

Long-term Fistula Formation Due to Retained Bullet in Lumbar Spine after Gunshot Injury: Se Il Jeon, Soo Bin Im, Je Hoon Jeong, Jang Gyu Cha; J Trauma Inj. 2017;30(2):51-54. Published online June 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.2.51

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Abstract PDF: We here report a case of long-term fistula formation due to bullet retention for 30 years in the lumbar spine after a gunshot injury, and describe its treatment. A 62-year-old male visited our hospital due to pus-like discharge from his left flank. The discharge had been present for 30 years, since his recovery from an abdominal gunshot injury. A spine radiography showed radiopaque material in the body of the third lumbar vertebra. Foreign body was removed using an anterolateral retroperitoneal approach. The postoperative course was uneventful. The patient was discharged 7 days after the operation and was followed-up for 8 months, during which time, the fistula did not reoccur. A bullet retained long term in the vertebral body may cause obstinate osteomyelitis and fistula formation. A fistula caused by a foreign body in the spine can be effectively treated by surgical removal.; Summary

A Gunshot Wounds to the Cervical Spine and the Cervical Spinal Cord: A Case Report: Sung Hwa Paeng; J Korean Soc Traumatol. 2012;25(2):57-62.

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Abstract PDF: Gunshot wounds are rare in Korea, but they have tended to increase recently. We experienced an interesting case of penetrating gunshot injuries to the cervical spine with migration the fragments of the bullet within the dural sac of the cervical spine,so discuss the pathomechanics, treatment and complications of gunshot wounds to the spine and present a review of the literature. A 38-year-old man who had tried to commit suicide with a gun was admitted to our hospital with a penetrating injury to the anterior neck. the patient had quadriplegia. A Computed tomography (CT) scan and 3-dimensional CT of the spine showed destruction of the left lateral mass and lamina of the 5th cervical vertebra; the bullet and fragments were found at the level of the 5th cervical vertebra. The posterior approach was done. A total laminectomy and removal of the lateral mass of the 5th cervical vertebrae were performed, and bone fragments and pellets were removed from the spinal canal, but an intradurally retained pellets were not totally removed. A dural laceration was noted intraoperatively, and CSF leakage was observed, so dura repair was done watertightly with prolene 6-0. The dura repair site was covered with fibrin glue and Tachocomb(R) Immediately, a lumbar drain was done. Radiographs included a postoperative CT scan and X-rays. The postoperative neurological status of the patient was improved compared with the preoperative neurological status. however, the patients developed symptoms of menigitis. He received lumbar drainage(200~250 cc/day) and ventilator care. After two weeks, panperitonitis due to duodenal ulcer perforation was identified. Finally, the patient died because of sepsis.; Summary

Original Article

Treatment of Combat-related Gunshot and Explosive Injuries to the Extremities: Jung Eun Lee, Young Ho Lee, Goo Hyun Baek, Kyung Hag Lee, Young Jae Cho, Yeong Cheol Kim, Gil Joon Suh; J Trauma Inj. 2013;26(3):111-124.

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Abstract PDF: PURPOSE
We should prepare proper medical service for disaster control as South Korea is not free from terrorism and war, as we experienced through the two naval battles of the Yeonpyeong, one in 1999 and the other in 2002, the sinking of Cheonan in 2010, and the attack against the border island of Yeonpyeong in 2010. Moreover, North Korea's increasingly bellicose rhetoric and mounting military threats against the world demand instant action to address the issue. The aim of this article is to describe our experience with three patients with combat-related gunshot and explosive injuries to their extremities and to establish useful methods for the management of patients with combat-related injuries.
METHODS
Three personnel who had been injured by gunshot or explosion during either the second naval battle of the Yeonpyeong in 2002 or the attack against the border island of Yeonpyeong in 2010 were included in our retrospective analysis. There were one case of gunshot injury and two cases of explosive injuries to the extremities, and the injured regions were the left hand, the right foot, and the right humerus. In one case, the patient had accompanying abdominal injuries, and his vital signs were unstable. He recovered after early initial management and appropriate emergency surgery.
RESULTS
All patients underwent emergent surgical debridement and temporary fixation surgery in the same military hospital immediately after their evacuations from the combat area. After that, continuous administration of antibiotics and wound care were performed, and definite reconstructions were carried out in a delayed manner. In the two cases in which flap operations for soft tissue coverage were required, one operation was performed 5 weeks after the injury, and the other operation was performed 7 weeks after the injury. Definite procedures for osteosynthesis were performed at 3 months in all cases. Complete union and adequate functional recovery were achieved in all cases.
CONCLUSION
The patient should be stabilized and any life-threatening injuries must first be evaluated and treated with damage control surgery. Staged treatment and strict adherence to traditional principles for open fractures are recommended for combat-related gunshot and explosive injuries to the extremities.; Summary

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