Penetrating gunshot injury

Penetrating gunshot injury is a rarely seen but a life threatening condition. Priorly stabilization of the patient’s vital signs with saline infusion, and compression of bleeding sites should be provided. Then transfer into an advanced life support facilities must be the second step. Here we present a 17-year-old female patient who had a penetrating gunshot injury during the ongoing war in Kobani, Syria. The first aid was provided successfully in the field and the patient was admitted to our emergency department with improved vital signs. Her blood pressure (112/65 mmHg), pulse rate (97 bpm), body temperature (36.4°C) and respiratory rate (19/min) were measured. On physical examination a large bullet entry wound on her left breast without any exit site was detected. Thoraco-abdominal computed tomography revealed multiple missiles in breast (Figure 1A), one in liver (Figure 1B) and one in the left ventricle (Figure 1C) with left pleural bleeding. Abdominal ultrasonography showed abdominal fluid which was attributed to trauma to liver. Trans-thoracic echocardiography revealed normal left ventricle ejection fraction and valve functions without any pericardial effusion. The patient was referred to a tertiary hospital for multidisciplinary approach. There the patient has undergone a successful liver repair operation and tube drainage of pleura. Resection of the missiles from the breast was also performed. Continuous echocardiography was performed for evaluation of cardiac performance and pericardial effusion. Luckily there were no need for cardiac surgery and the patient was discharged without any disability. By presenting this case image we would like to remind a very rare condition; penetration gunshot injury and the management of it. Multidisciplinary approach to casualties like this is crucial for keeping the patients alive.