Gunshot wounds of the abdomen: association of surface wounds with internal injuries.

OBJECTIVE To evaluate and quantify the correlation between surface wounds and internal injuries. METHODS The medical records of 55 patients, admitted over a two year period with a diagnosis of gunshot wound of abdomen, were reviewed retrospectively. Imaginary trajectories of each bullet track were reconstructed on real scale abdominal anatomy models, and data regarding expected injuries was obtained. This data was then matched with the laparotomy findings for each patient and the percent correlation between observed and expected injuries was calculated. RESULTS The mean correlation between expected and observed injuries was found to be 31%. Most of the wounds were in the upper abdomen, and the correlation was strongest for fixed organs such as liver and lowest for mobile viscera like small intestine. CONCLUSIONS The assessment of internal injuries on the basis of entrance and exit wounds is hazardous, due to cavitation and ricochet effects of bullets. The chances of visceral injuries remote from the trajectory are greater than 50%.