Intrauterine penetrating direct fetal head trauma following gunshot injury: a case report and review of the literature.
METHODS
An unusual case of an intrauterine penetrating head injury due to a pellet from an airgun is described. A 28-year-old pregnant woman, at term, shot herself intravaginally with a toy BB gun. Following a spontaneous precipitous vaginal delivery, the neonate presented with persistent seizure disorder, meningitis, cerebritis, and a right parietal region scalp swelling. Imaging studies revealed intracranial hemorrhage, and the metallic pellet was adjacent to the right lateral ventricle, which was removed through a parietal craniotomy. Computed tomography of the brain after 1 week demonstrated early abscess formation in the left frontal operculum and a subdural empyema in the posterior fossa. The abscesses were evacuated, and the meningitis was treated vigorously with broad-spectrum antibiotics. Although well for the past 6 years, the child demonstrates significant mental handicap and developmental delay.


CONCLUSIONS
The pathogenesis, management, and medicolegal issues pertaining to the above case are discussed, and the relevant literature is briefly reviewed.
Muzumdar
Dattatraya
D
Division of Neurosurgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8 L1, Canada.
Higgins
Michael J
MJ
Ventureyra
Enrique C G
EC
D000328:Adult; D001925:Brain Damage, Chronic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D002648:Child; D002658:Developmental Disabilities / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005333:Fetus; D005547:Foreign Bodies / Q000150:complications* / Q000628:therapy; D020197:Head Injuries, Penetrating / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D008297:Male; D011247:Pregnancy; D049188:Prenatal Injuries / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D012640:Seizures / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D016728:Self-Injurious Behavior / Q000150:complications*; D014948:Wounds, Gunshot / Q000150:complications* / Q000628:therapy