MACROSCOPIC AND MICROSCOPIC FEATURES OF FIREARM PENETRATING ABDOMINAL INJURIES WITH DAMAGE TO THE APPENDIX

Abstract

Introduction. In the structure of combat abdominal trauma during all periods of hostilities (according to ATO/JFO data), gunshot wounds dominated, accounting for 87.1%. An analysis of the distribution of those injured with gunshot wounds by the type of projectile causing the injury showed a prevalence of shrapnel injuries over bullet wounds – more than 80%.
 The aim of the research was to analyze the macroscopic and microscopic changes in firearm penetrating abdominal injuries with damage to the appendix.
 Materials and Methods. Eight appendectomies were performed due to firearm penetrating abdominal injuries with damage to the appendix. Complaints, medical history, examination data, ultrasound examination according to the FAST protocol, and radiological examinations were studied in all injured patients. To refine the diagnosis and determine the scope of surgical intervention, the WOLF videoendoscopic system was used.
 Histological examination of the removed appendices was performed, which were stained with hematoxylin and eosin and with the Van Gieson stain. A complex of pathomorphological studies was conducted using the Primo Star microscope (Carl Zeiss) at a magnification of ×140.
 Results. All injuries occurred while wearing a bulletproof vest and were characterized as blind, with 1 (12.5%) being gunshot wounds and 7 (87.5%) being shrapnel wounds. The entrance wound in firearm blind penetrating abdominal injuries with appendix damage was located in the right hypochondriac region – 4 (50%), right flank – 1 (12.5%), right inguinal region – 2 (25%), and mesogastric region – 1 (12.5%) cases. The average size of the entrance wound on the skin was 23.3±0.4×12.4±0.3 cm. All skin wounds were outside the bulletproof vest protection area.
 The injuries to the appendix had an average size of 15.4±1.2×9.3±0.1 cm. All removed foreign bodies were larger than 1 cm in their largest dimension.
 Conclusions. In most cases of firearm penetrating abdominal injuries, damage to the appendix is noted with an entrance wound predominantly on the right side. Macroscopically, in firearm blind penetrating abdominal injuries with appendix involvement, the wound on the skin is larger than on the appendix. All foreign metal bodies removed from the abdominal cavity after firearm shrapnel blind abdominal injuries with appendix involvement were of large size. Contusional injuries to the appendix tend to undergo destructive transformation, requiring surgical treatment - appendectomy. The increased frequency of appendix injuries can be explained by the widespread use of shrapnel ammunition in abdominal injuries when personal protective equipment does not provide protection for this area.