Anterior Abdominal Vulnus Sclopetarium (Gunshot Wound) with Incidental Intra Luminal Bullet: A Case Report

Introduction: Gastric perforation is one of the most common abdominal emergencies. That perforation can be caused by penetrating or blunt trauma. Injuries to the stomach are associated with the highest mortality of all hollow viscus injuries. Penetrating trauma leading to gastric perforation is more common than blunt trauma. In gastric perforation, gastric juice flows out to the abdominal cavity causing peritonitis which can develop into sepsis if remains untreated.

Case Presentation: A patient presented with abdominal pain in almost all regions of the abdomen. A 0.4-cm gunshot wound was found on the right side of the abdomen, with decreased bowel sound, pressure pain in all abdominal regions, and positive muscular defense. On abdominal x-ray imaging, the bullet was located in the abdominal cavity. On the anteroposterior view, it was projected on the right side of L2-3 vertebrae, 15.3 cm from the marker, and in the lateral view, the bullet was projected on L4-5 vertebrae, 16.8 cm from the marker. The bullet penetrates the stomach and caused an entry wound but no exit wound was found while the bullet found in the intestine. Operation findings a 0.4-cm air rifle bullet in ascending colon.

Management and Outcome: Exploratory laparotomy with primary suture of gastric perforation, bullet extraction from ascending colon, and primary repair of ascending colon were performed.

Discussion: Exploratory laparotomy is still the main surgical procedure of choice for patients with gastric perforation. Exploration is carried out with full visualization of the anterior surface of the pylorus to the esophago-gastric junction. The posterior surface of the stomach is freed from the gastro-colic ligament allowing exploration of the minor sac.