A study was taken up with the objective of reporting the pattern and incidence of fatal firearm injuries in Delhi and comparing it with the pattern seen in other countries. One hundred and seven firearm fatalities autopsied during the last 6 years were studied. A 55-year-old male patient came to the casualty of a medical college and hospital with an alleged history of assault with firearm injury on his back. The present study was conducted at Medical College and Hospital in Central India. The patient was conscious with GCS 15/15, his pulse rate was 133 beats per minute, blood pressure was 100/60 mmHg, SpO2 was 95% and pallor was present. On local examination, there was a single entry wound at the lower back on the left side of size 1 cm X 1 cm with no exit wound. Generalized abdominal tenderness and guarding were present. The patient was immediately resuscitated. Blood grouping and cross-match were sent immediately. The abdominal radiograph did not show any gas under the diaphragm but a foreign body (a bullet) was seen. Ultrasonography and computerized tomography scan of the abdomen were suggestive of hemoperitonium and a foreign body bullet in the abdomen. Exploratory laparotomy showed moderate hemoperitonium of about 1000 ml which was sucked out completely. Evidence of retroperitoneal rent of size approximately 1 cm X 1 cm was seen with oozing through it which was closed in layers. A bullet was seen in the anterior abdominal wall but the skin was intact. Five jejunal perforations distal to 20 cm from the duodenojejunal flexure were seen and the bullet was removed from the anterior abdominal wall. Resection of the jejunal segment with jejuno-jejunal anastomosis was done. Jejunal mesenteric rents were closed. The abdominal wall is closed in layers. Post-operative recovery was uneventful. The patient was kept nil by mouth for 7 days, jejunal feeding started on the 7th postoperative day. The patient was discharged on the 10th postoperative day. The case report revealed that the amount of work or damage inflicted on tissues depends on the amount of kinetic energy possessed by the bullet when it strikes the body and the amount possessed when, and if, it exits the body. The chest (39%) and head (29.6%) were the two most common entry sites for the bullets, a pattern somewhat similar to that of other countries. Moreover, in gunshot wounds (GSW), the possibility of intra-abdominal injuries is high, and the necessity of surgical treatment is the rule. To perform this type of treatment, the hospital must be prepared, equipped with human and material resources and have a well-defined protocol and the necessary infrastructure. The study concluded that early diagnosis and treatment in the golden hours can save the lives of the patients. A mass education on the dangers of these guns and the harm they can cause as well as legal regulations for their restricted use seem to be necessary.
Author (s) Details
Ashok S. Gajbhiye
Department of General Surgery, Indira Gandhi Government Medical College and
Hospital, Nagpur, Maharashtra, India.
Mrunal Nikhade
Karmveer M.S. Kannamwar, Government Medical College, Chandrapur,
Maharashtra, India.
M. N. Deshmukh
Department of General Surgery, Indira Gandhi Government Medical College and
Hospital, Nagpur, Maharashtra, India.
Parag Jaipuriya
Department of General Surgery, Indira Gandhi Government Medical College and
Hospital, Nagpur, Maharashtra, India.
Kishor Jehughale
Department of General Surgery, Indira Gandhi Government Medical College and
Hospital, Nagpur, Maharashtra, India.
P. Mehata
Department of General Surgery, Indira Gandhi Government Medical College and
Hospital, Nagpur, Maharashtra, India.
Abhinav Kumar
Department of General Surgery, Indira Gandhi Government Medical College and
Hospital,
Ankur Kumar
Department of General Surgery, Indira Gandhi Government Medical College and
Hospital, Nagpur, Maharashtra,
India.
Please see the book here:- https://doi.org/10.9734/bpi/msraa/v2/3066
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