In patients presenting with gunshot wounds, a high clinical suspicion of injury to vasculature and viscera remote from the projectile track is paramount. We present a case of a 17 year old male who sustained a gunshot wound to his abdomen and subsequently developed a right external iliac artery contusion requiring surgery as an indirect effect of the pressure wave from the bullet.
Adolescent ; Humans ; Iliac Artery ; injuries ; Male ; Pressure ; Wounds, Gunshot ; complications ; surgery

Gunshot injuries are getting more frequently reported while the civilian (nongovernmental) armament increases in the world. A 42-year-old male patient presented to emergency room of Istanbul Medipol University Hospital due to a low-velocity gunshot injury. We detected one entry point on the posterior aspect of the thigh, just superior to the popliteal groove. No exit wound was detected on his physical examination. There was swelling around the knee and range of motion was limited due to pain and swelling. Neurological and vascular examinations were intact. Following the initial assessment, the vascular examination was confirmed by doppler ultrasonography of the related extremity. There were no signs of compartment syndrome in the preoperative physical examination. A bullet was detected in the knee joint on the initial X-rays. Immediately after releasing the tourniquet, swelling of the anterolateral compartment of the leg and pulse deficiency was detected on foot in the dorsalis pedis artery. Although the arthroscopic removal of intra-articular bullets following gunshot injuries seems to have low morbidity rates, it should always be considered that the articular capsule may have been ruptured and the fluids used during the operation may leak into surrounding tissues and result in compartment syndrome.
Adult ; Arthroscopy/*adverse effects ; *Compartment Syndromes ; Humans ; Knee Injuries/*surgery ; Male ; *Postoperative Complications ; Turkey ; *Wounds, Gunshot

OBJECTIVETo explore the clinical characteristics and the effect of surgical therapy for shotgun injuries of the sciatic nerve.

METHODSFrom 1996 to 2000, 19 sciatic nerve injuries resulted from shotgun were observed. Among 19 cases of shotgun sciatic nerve wounds, the gluteal wound was in 2 cases, thigh wound in 15 cases, and knee wound in 2 cases. The firing distance was between 0.5-9 m. According to Shermen classification of shotgun injury, 4 cases belonged to type I injury, 11 cases type II, 4 cases type III. The time from injury to admission was between 2 months-14 months except 1 patient who underwent emergency operation 4 hours after injury, and 1 patient was treated with debridement and epineurial neurorrhaphy, 7 cases with nerve trunk grafting, 6 cases with nerve cable grafting, 4 cases with neurolysis, 1 case with arthrodesis of ankle.

RESULTSNineteen cases were followed-up for 0.8-3.5 years (mean, 19 months). The excellent and good nerve functional recovery was found in 52.6% according to MCRR.

CONCLUSIONSShotgun injuries of the sciatic nerve are very severe and complicated, and injuries in most patients were usually complicated by open fracture, vascular injury, soft-tissue loss and infection; the character of nerve injury was classified as 4-5 degree according to Sunderland Standard, nerve transfer is effective in the treatment of shotgun injuries of the sciatic nerve, but outcome is poor; the recovery of the sciatic nerve should be observed continually after injury; selecting correct initial treatment after injury, strict minimally invasive surgical procedure, physical therapy and reasonable preoperative and postoperative medication can improve the surgical results.

Adolescent ; Adult ; Follow-Up Studies ; Humans ; Male ; Patient Satisfaction ; Sciatic Nerve ; injuries ; surgery ; Treatment Outcome ; Wounds, Gunshot ; complications ; rehabilitation ; surgery

OBJECTIVE: Civilian gunshot injuries to the brain are relatively rare and study of these injuries has been neglected in South Korea. We present our experience with penetrating gunshot injuries to the brain and review the outcome of surgical management, as well as other clinical predictors influencing the prognosis. METHODS: We present a retrospective analysis of 13 patients with penetrating gunshot injuries to the brain who were treated at our hospital over a period of 22 years. RESULTS: The Glasgow Coma Scale(GCS) score on admission was recorded to be : 3-5 in 1 patient, 6-8 in 3 patients, 9-12 in 2 patients and 13-15 in 7 patients. There were 11 patients who underwent surgical treatment, and the surgical mortality rate was 0%. The admission GCS score was the most valuable prognostic factor. The best results were found to be in patients admitted with an initial GCS higher than 13. There were no favorable outcomes in patients admitted with a GCS of 8 or lower. There was a correlation between the presence of a transventricular or bihemispheric trajectory and poor outcome. The patients admitted with unilobar wounds resulted in better outcome than those with bilobar or multilobar wounds. Retained deep intracranial bone or metal fragments were the most common postoperative complication. However, retained fragments did not increase the risk of infection or seizure. CONCLUSION: Our results suggest that a less aggressive approach, consisting of minimal local debridement and removal of the bone and metal fragments that are easily accessible, can be successfully used in civilian gunshot wounds to the brain.
Brain Injuries ; Brain* ; Coma ; Debridement ; Glasgow Coma Scale ; Humans ; Korea ; Mortality ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Seizures ; Wounds and Injuries ; Wounds, Gunshot

The authors report a rare case of air gunshot wound to the thoracic spinal cord in Korea. A case of 17 year-old girl with a air-gunshot wound to the thoracic spine was presented with paraplegia. Radiologic studies revealed a bullet in the fifth thoracic spinal canal. The cerebrospinal fluid leaked through the entry point of the bullet was noted. After laminectomy and dural opening, a intramedullary hematoma with lodged bullet in the contused cord was found. They are removed successfully with any postoperative complications. The bullet was composed of lead. We report this case focusing on the pathophysiology and surgical treatment with review of literatures.
Adolescent ; Cerebrospinal Fluid ; Female ; Hematoma ; Humans ; Korea ; Laminectomy ; Paraplegia ; Postoperative Complications ; Spinal Canal ; Spinal Cord ; Spinal Cord Injuries ; Spine* ; Wounds and Injuries* ; Wounds, Gunshot

Adult ; Airway Obstruction ; etiology ; Cervical Vertebrae ; diagnostic imaging ; injuries ; Fatal Outcome ; Humans ; Male ; Tomography, X-Ray Computed ; Tracheostomy ; Wounds, Gunshot ; complications ; diagnostic imaging

The radiologic and clinical findings of foreign bodies in the chest of children are well recognized. Foreign bodies in adults are infrequent, however, and the radiologic findings of these unusual circumstances have rarely been described. We classified various thoracic foreign bodies into three types according to their cause: Type I, Aspiration, Type II, Trauma or Accident; Type III, Iatrogenic. This pictorial essay will illustrate the radiologic findings and consequences of thoracic foreign bodies in adults, which have rarely been described in the radiologic literature. The clinical significance of thoracic foreign bodies will be also be discussed.
Accidents ; Adolescent ; Adult ; Aged ; Aspiration ; Esophagus/radiography ; Female ; Foreign Bodies/*etiology/*radiography ; Heart/radiography ; Human ; Iatrogenic Disease ; Male ; Middle Age ; Radiography, Thoracic ; Support, Non-U.S. Gov't ; *Thorax ; Wounds and Injuries/complications ; Wounds, Gunshot/complications

Adrenal gland trauma is a rare phenomenon, due to the small size and retroperitoneal location of the organ. The majority of adrenal gland trauma is due to blunt force injury and is only rarely encountered due to the penetrating mechanisms. A 20-year-old male sustained a gunshot wound to the left abdomen. Upon exploration, he was found to have a through and through injury to the left adrenal gland, among other injuries. Injury to the adrenal gland due to penetrating trauma is exceptionally rare. The principles of management are to control bleeding from the gland with debridement and hemostasis rather than attempt to resect the entire organ. The management of a penetrating injury to the adrenal gland is straightforward and should not be a contributor to a patient's morbidity or mortality.
Adrenal Glands ; diagnostic imaging ; injuries ; Adult ; Debridement ; Hemorrhage ; etiology ; therapy ; Hemostasis, Surgical ; Humans ; Laparotomy ; Male ; Multiple Trauma ; therapy ; Organ Sparing Treatments ; methods ; Tomography, X-Ray Computed ; Treatment Outcome ; Wounds, Gunshot ; complications ; diagnostic imaging ; therapy ; Young Adult