Atypical gunshot wound: Bullet trajectory analyzed by computed tomography.
BACKGROUND
Gunshot injuries are a result of a bullet or projectile fired from a weapon that penetrates the body. Homicide, suicide, and occasionally, accidental events are a significant cause of firearm-related injuries. In rare cases, the damage from the gunshot injury can be masked due to an atypical bullet trajectory.


METHODS
A 63-year-old male was found with a gunshot wound to the anterior left knee. Computed tomography (CT) scans revealed a bullet track extending from the anterior aspect of the left knee that traveled cephalad subcutaneously and entered into the peritoneal cavity, perforating the distal descending colon. The bullet was found to be at rest adjacent to the spleen and posterior chest wall, with no injury to the lungs, kidneys or the spleen. The patient required a sigmoid colectomy with descending colostomy and was subsequently discharged home without any complications.


CONCLUSIONS
Intra-abdominal organ damage from a gunshot wound to the distal limb is a rare occurrence. Atypical gun shot wounds, such as this case, have the potential for multiple issues including: delayed diagnostic tests, inaccurate radiological readings, and inappropriate medical management.


CONCLUSIONS
If an abnormal trajectory is maintained, it is possible for a bullet to traverse half the length of the body without the patient realizing it. Accurate CT analysis and quick decisions in surgical and medical management are critical takeaways to provide quality care to patients with these injuries.
School of Medicine, Texas Tech University Health Sciences Center, 1400 S Coulter St., Amarillo, TX 79106, USA. Electronic address: notaehoon@gmail.com.
Tae
T
Ro
Department of Radiology, Northwest Texas Hospital, Amarillo, TX, USA. Electronic address: rickym8111@yahoo.com.
Richard
R
Murray
Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA. Electronic address: dan.galvan@ttuhsc.edu.
Dan
D
Galvan
Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA. Electronic address: muhammad.nazim@ttuhsc.edu.
Muhammad H
MH
Nazim
Atypical gunshot wound; Colostomy; Computed tomography; Critical care; Trauma