Abstract
Gunshot injuries involving the head and neck region yield profound morbidity and mortality rates. Projectile-related factors comprising various physical and dynamic properties of a bullet, as well as tissue-related factors, determine the disruptive effects of projectiles on living tissues. We experienced an extremely unusual case of a gunshot injury to the neck, wherein the bullet transversely penetrated across the deep neck structures to the contralateral side of the shoulder without damaging any vital organs. A 51-year-old man presented with a gunshot wound to the neck from a point-blank range. A bullet entry hole was observed on the left side of the neck without an exit hole; however, the patient was conscious, vital signs were normal, and no active bleeding, cranial nerve palsy, or aero-digestive tract injury was found. Imaging tests revealed a bullet lying in front of the right humeral head, which was extracted by emergency surgery. The patient was uneventfully discharged. According to the localization of the damaged tissues and the positional relationship between the bullet’s entrance and its destination, the bullet was estimated to have nonlinearly traversed the neck by traveling through the interstructural spaces associated with the least tissue resistance. Our experience strongly suggests the importance of realizing the unpredictable nature of a bullet trajectory in a body. An appropriate understanding of various ballistic factors and wounding mechanisms can be of great help in the adequate assessment and management of patients with gunshot injuries.
Highlights
IntroductionGunshot injuries involving the head and neck confer a high potential for profound morbidity and mortality rates by damaging vital neurovascular structures, including the central nervous system, carotid arteries, and jugular veins [1]
This article is part of the Topical Collection on SurgeryGunshot injuries involving the head and neck confer a high potential for profound morbidity and mortality rates by damaging vital neurovascular structures, including the central nervous system, carotid arteries, and jugular veins [1]
A 51-year-old man presented to the emergency outpatient room of Kawasaki Municipal Kawasaki Hospital because of gunshot wounds resulting from a local gang conflict in the vicinity
Summary
Gunshot injuries involving the head and neck confer a high potential for profound morbidity and mortality rates by damaging vital neurovascular structures, including the central nervous system, carotid arteries, and jugular veins [1]. The age-standardized mortality rate associated with firearm injury in Japan was estimated to be less than 0.2 per 100,000 persons in 2016, representing the second-lowest worldwide [2] These low gun-related death rates are principally attributed to stringent Japanese laws that do not allow civilians to possess or use guns for any reason. We present an extremely unusual case of a gunshot injury traversing the neck, wherein the bullet nonlinearly traveled through the deep structures to the contralateral side of the shoulder without damaging any vital organs. A 51-year-old man presented to the emergency outpatient room of Kawasaki Municipal Kawasaki Hospital because of gunshot wounds resulting from a local gang conflict in the vicinity He was shot twice on the left side of the neck and face from point-blank range. Because the patient did not return to the orthopedic outpatient clinic, possible improvement in his right brachial function remained unknown
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