Surgical treatment features of liver gunshot wound with a dumdum bullet (expanding bullet)

Abstract

IntroductionLiver injury is one of the most common abdominal traumas. The causes of military activity related injuries are gunshot wounds (up to 60–70%), while in peacetime—closed blunt abdominal trauma (up to 45–55%). The overall mortality is up to 40–60% and has higher rates in the group of wartime injury, among the male population over 65 years old and of low social status.Presentation of the caseWe report the management of a clinical case of a 34-year-old man with thoracoabdominal dumdum’s bullet trauma in the case of which damage control tactics were applied in cooperation between two clinics in conditions of active hostilities.DiscussionsTreatment of patients with abdominal injuries should be guided by the principles of damage control. This tactic requires stabilization of the patient's condition at the initial stage, followed by the completion of the final volume of surgical treatment in a compensated state of the patient. Liver injuries represent an ideal model for the application of damage control surgery in wartime settings and require close coordination between clinics that perform primary and delayed surgical interventions. Minimizing the volume of surgical intervention at the stage of primary control of bleeding due to liver damage provides the most optimal immediate results in conditions of a hemodynamically unstable patients, simultaneous admission of a large number of wounded, and a limited clinic resource.ConclusionThis surgical history research is an example of the effectively organized and coordinated work of two clinics such as National Military Medical Clinical Center “Main Military Clinical Hospital” and Shalimov National Institute of Surgery and Transplantation, based on the principle of damage control in conditions of active hostilities.