Gunshot Injury of Head and Neck Region with an Atypical Bullet Trajectory: The Importance of Whole Body Computed Tomography Scan.

Abstract

Nowadays, gunshot injuries have become a common medical-legal issue because of easy accessibility of firearms. Gunshot injuries of head and neck region are highly morbid and fatal, particularly when they affect vital organs. In rare cases, atypical tract lines resulting from such injuries can cause difficulties in the diagnosis and treatment. In this report, a high energy gunshot injury involving head and neck region with an atypical bullet trajectory is presented. A 24-year male soldier was brought to the emergency department on account of gunshot injury following a conflict. Although the entrance and exit holes of bullets were confined to head and neck region, the whole body computed tomography scan was carried out in spite of his borderline hemodynamics. Whole body computed tomography revealed massive hemopneumothorax, mediastinal shift, hepatic laceration, and foreign body (bullet) in the liver. The patient was operated successfully by a multidisciplinary surgical team on emergency basis. This report highlights the necessity and importance of whole body computed tomography scan in such cases.