Abdominal gunshot injury with perforation of both iliac arteries

Abstract

A 15-year-old youngster was hit in the abdomen by a 22 caliber rifle bullet. After a short, symptom-free interval, he collapsed and was transported rapidly to the nearest medical center. He showed severe shock and anemia. An explorative laparotomy was performed immediately and an extended retroperitoneal hematoma is discovered, originating from perforation of both common iliac arteries. The lesions and an additional perforation of the ileum were sutured directly. The bullet was excised. The wound healed without complications and the patient recovered completely. The short duration of the rescue chain and the prompt laparotomy with clamping of the aorta are probably what saved this young patient's life. The particular vascular reconstruction in this case, the excision of the bullet, sufficient drainage, and prophylactic administration of antibiotics helped avoid septic complications. Fortunately, it was not a high velocity penetration, which would have demanded a very different treatment. Exact information about the rifle and cartridge, as well as the right strategy in treatment are mandatory for successful management of such dangerous injuries.