Case Of Gunshot Wound Research Articles

Homicides Disguised as Staged Suicides.

Determining the correct cause and manner of death are among the chief responsibilities of the forensic pathologist. When confronted with a case having a questionable manner of death, it is important for scene evidence, witness statements, and forensic autopsy findings to be thoroughly reviewed before certifying the manner of death. Herein three gunshot wound cases are presented which initially were suspected to be suicides but were instead determined to be homicides through full investigations with correlation to autopsy findings.

Ангіохірургічна допомога в Україні під час операції Об’єднаних сил на Сході України в період з 2014 по 2020 рік

SummaryAim: to analyze the mechanism, nature of injuries, including localization andconcomitant injuries, in patients with injuries of the large vessels during the Joint Forceoperation (JFO) in eastern Ukraine for the period 2014–2020.Materials and methods. We analyzed 234 cases of gunshot wounds of the largevessels during the JFO in the East of Ukraine in the period from February 2014 toFebruary 2020, who were treated at the Military Medical Clinical Centers of Ukraine atthe stages of medical evacuation.Results and conclusions: 1. The most cases of injuries of large vessels wererecorded in 2014, which is 24.8% of all identified such cases, the least – in 2020, whichis 3.5%. 2. When studying the mechanism of trauma, the greatest number of injuries ofthe large vessels was registered with shrapnel wounds, accounting for 37.6%, and withmine-explosive injury – 25.6%. 3. When studying the frequency of vascular lesions, thegreatest number of injuries of the large vessels was recorded in trauma of the vessels ofthe lower extremities, namely, the femoral-popliteal segment – in 68.4% as well asvessels of the upper extremities – in 27.8%, of which the largest proportion was forartery damage – 47% of the total structure of such injury. 4. 70.5% studied cases areassociated with damage of bones and nerves. In 38.5%, the wounds are multiple andcover wounds of other anatomical sites. 5. The success of the treatment of injuries of thelarge vessels depends on the time factor. The best results were recorded in patients withthe shortest time from injury to specialized medical care.

Synergy of CT and MRI in detecting trajectories of lodged bullets in decedents and potential hazards concerning the heating and movement of bullets during MRI

The purpose of this study was to assess the value of magnetic resonance imaging (MRI) in addition to computed tomography (CT) in gunshot wound cases with bullets or pellets lodged inside the head. In this context, the potential heating and movement of the lodged bullets were additionally investigated using animal models. Eleven forensic cases of penetrating gunshot wounds underwent CT and MRI. The data of each imaging modality were reviewed according to the following relevant characteristics: bony lesion at the entrance, intracranial bone fragments, intracranial metal fragments, gunshot residues, the wound channel and the severity of metal artifacts. Four-point Likert scales were used for the assessment. The heating of projectiles and their magnetic field interactions with the static magnetic field were assessed using animal models. MRI presented major advantages in cases with transversal trajectories and non-ferromagnetic bullets compared to CT. In general, MRI enabled a clear visualization of the wound channel and gunshot-related soft tissue injuries. An image fusion of CT and MRI datasets demonstrated the individual strengths of both modalities. Radio frequency (RF)-induced heating due to bullets lodged inside the brain tissue was invalidated. The likelihood of ferromagnetic projectile migration inside brain tissue is low. MRI of decedents with a bullet lodged inside their heads is viable and provides a valuable supplement to CT. The in situ, noninvasive depiction of the wound channel and gunshot-related soft tissue injuries on MRI can contribute to the knowledge of wound ballistics.

Neck trauma: migrate foreign body

The cases of foreign bodies in the neck can be iatrogenic or traumatic. Cases of gunshot wounds, incisors and penetrating tool injuries are some of the examples. Large arteries and veins, trachea and neural structures can be damaged. The fact that the foreign body migrate in the neck structures and fascia is a rare but expected condition. Therefore, foreign bodies can be found in unexpected places. In our case, a 37-year-old male patient was consulted to our clinic with multiple cuts and foreign body. A foreign body was observed anterior to the cervical vertebra in the patient’s radiological imaging and underwent surgery emergently. After the migration, the foreign body was found and removed in the nasopharynx of the patient. In the practice of ear-nose-throat medicine. During the practice of Ear Nose and Throat specialty, attention should be paid to the foreign bodies of the neck because of their close relation with vital structures.

A Case of Gunshot Injury to the Spinal Cord in a Dog: Clinical, Surgical, and X-ray Features.

Case description- A five-year-old female dog, weighing 35 kg, was presented as an emergency case after it suffered a gunshot injury.Clinical findings - Physical examination of the dog revealed paraplegia, the symptoms were normal. There was no bone fracture and dislocation in the lower extremity examination. A bullet (diameter, 4 mm) between the third and fourth lumbar was observed on radiographic examination.Treatment and outcome- The bullet was about 4 × 7 mm long, which stuck between the longitudinal spine and carefully removed. In the examination of the spinal cord, the rupture was observed relatively in some longitudinal strands, and no necrosis was present in the site. After the surgery, the dog was discharged with a good condition.Clinical relevance- As a consequence, a precise evaluation of the gunshot injury to the spinal cord could not be achieved by imaging, which made a prediction of the prognosis difficult prior to surgery. Therefore, if imaging tests provide evidence of a direct impact on the spinal cord, surgery should be considered a primary method to prevent irreversible harm necrosis of the spinal cord.

Heart injuries: main clinical symptoms

Injuries to the heart are uncommon in peacetime, yet they result in life-threatening conditions, which makes timely diagnostics a crucial factor in saving patients' lives. In this connection, it is important to define the main signs of heart injuries. This study aimed to analyze the basic clinical symptoms associated with various wounds to the heart. We have retrospectively analyzed such symptoms registered in 86 patients with varying chest injuries that affect the heart. All patients were treated in the emergency surgery unit of the Engels Town Hospital from 1991 to 2017. 41 (47.6%) patient had stab wounds, and there were 45 (52.3%) cases of gunshot wounds. 23 (26.7%) patients had chest injuries affecting heart exclusively, while for 63 (73.2%) the consequences were wounds to other organs. We found that the clinical picture depends on the kind of injury to the heart: stab and slash wounds translate into more pronounced symptoms, while gunshot wounds do not produce such an effect. Accepting patients, practitioners should take this fact into account. The misdiagnosis rate for stab and slash heart wounds is 9.7%, that for gunshot wounds — 17.7%, the latter being the result of vagueness of the clinical picture. The clinical signs are most pronounced in the cases of stab and slash wounds to the heart.

Emphasising the importance and evaluation of contributions of pre-morbid disorders to death in medicolegal autopsies

Background: The role of the anatomical pathologist is very crucial in the investigation of deaths in suspicious circumstances. It entails thorough dissection, scrutiny of organ changes and sound intellectual processes to guide legal authorities to take proper decisions based on medicolegal reports of autopsies.Aims and Objectives: The aim of this study was to establish the presence of pre-morbid conditions in deceased persons during medicolegal autopsies and to ascertain the contributions of pre-morbid diseases to the process of death.Materials and Methods: A retrospective analysis of medicolegal autopsy records over eleven years (2007-2017) was done and the data was analyzed by simple descriptive statistical methods. The inclusion criteria were disorders that predated the medicolegal event resulting in death. Conditions known to be pathophysiological components of the medicolegal event were excluded from the study. Results: A total of 246 cases were considered but only 10 cases met the inclusion criteria. The manner of death in four of the cases within the inclusion criteria were accidental deaths, including three cases of road traffic accident and one case of aircraft crash. There were three cases of infective illness, one case of gunshot injury to the head, one case of death from occupational hazard and one case of death due to injuries from machete cuts. The pre-medical conditions in most of the cases on strict morphological assessment were incidental findings and were not deemed to be contributory in any way to the process of death. Conclusion: It is very important for the anatomical pathologist to probe meticulously for the cause of death and explain the role of every lesion seen at autopsy in the process of death. This is necessary so as to avoid doubts, the insinuations of incomplete autopsies and unnecessary controversies in medicolegal cases.

CEUS in gunshot wound of the liver – first experience in military mission

Purpose Computed tomography (CT) is the gold standard technique in gunshot injuries imaging. In military missions and in case of mass casualties availability of CT scanning and capacity of airborne transporting may be limited. FAST (Focused Assessment with Sonography in Trauma) remains the primary imaging examination in abdominal trauma. Contrast-enhanced ultrasound (CEUS) could close the diagnostic gap between CT scanning and FAST and back-up shortage of diagnostic avail- abilities. Material and methods We report a case of gunshot wound of the liver during military mission in Afghanistan. FAST and CT scanning were done as first diagnostic imaging. CEUS was performed additionally in the emergency room by CX 50 Philips ultrasoundsystem and SonoVue contrast agent. CEUS was repeated after each following operation and also done intraoperative to estimate the damage of the liver and hematoma. Results The wound track extension of traumatic gunshot wound could not be estimated on first CEUS examination due to aerodermectasia and gas echo extended along the wound track. Subsequent CEUS after first operations revealed that the wound track echo was unenhanced in majority. CEUS effectively detected the wound tract, hematoma, and the liver area injured by the gunshot and could accurately reveal necrotic tissue in the injured area and differentiate it from normal tissue. Conclusions Application of CEUS may provide important imaging for gunshot wound debridement in its follow up and avoid repeated CT scannings. Thus may spare time and transport capacity in millitary missions. CEUS is an interesting diagnostic tool in blunt and gunshot trauma of the abdomen.

Postmortem computed tomography and autopsy for detection of lesions and causes of death in gunshot injury cases: a comparative study

BackgroundFirearm injuries are a common cause of death in cases typically investigated by medical examiners. Postmortem multislice computed tomography (PMCT) provides valuable information that enhances the autopsy examination. This study was conducted to compare PMCT and autopsy for the detection of injuries and causes of death in cases of fatal firearm injuries. Thirty cadavers were scanned with PMCT and then underwent autopsy. The results of the two techniques were compared regarding entry wounds, wound channels, detection of foreign bodies, organ and skeletal injuries, and causes of death to determine the concordance or discordance between the two techniques.ResultsThe results revealed excellent agreement between PMCT and autopsy for the detection of injuries and causes of death in cases of gunshot injury. Furthermore, PMCT revealed injuries such as pneumothorax and surgical emphysema that were found to be undetermined by autopsies where the special dissection technique was not part of our routine procedures.ConclusionPMCT could be a valuable complementary tool for autopsies to determine and localize injuries and causes of death in cases of gunshot injury.

Indications and Pattern of Limb Amputation: A Tertiary Hospital Experience, South-South, Nigeria

The aim of this paper was to study the indications and patterns of limb amputations in the University of Calabar Teaching Hospital, a retrospective study of 142 limb amputations performed in patients admitted to the University of Calabar Teaching Hospital, South-South, Nigeria. Data was obtained from theater records and the medical record department of the hospital after due ethical approval. The data spanned a period of 10 years (from January 2004 to December 2014). A total of 142 patients were seen. The age ranged from 8 to 87 years with a mean age of 46 years ± SD 17.9 years and a male to female ratio of 2.3:1. Adults accounted for 95.8% while 4.2% were children. Emergency procedures accounted for 47.9% of the amputations. Diabetic foot gangrene was the major cause of lower limb amputation 91 (64.1%), trauma accounted for 27 (19%) of these, 15.5% were due to road traffic accidents, and 3.5% were cases of gunshot injuries. Tumors and limb ischemia accounted for 9.2 and 2.8%, respectively. Electrical injury, industrial accidents, and ischemic limbs from tight tourniquet splints by traditional bonesetters were the common causes of upper limb amputations. Most of the amputations were on the lower limb (83.7%) with the left lower limb accounting for 47.8% and the right lower limb accounting for 35.9% .Upper limb amputations accounted for 15.4% with right and left upper limbs being 8.4 and 7.0%, respectively .Only one patient had bilateral lower limb amputation(0.7%). For the levels of amputation, the majority were below knee 54 (38%) followed by above elbow 38 (26.8%) amputations (Figure 1); others were ray amputation of the foot and hand as 28 (19.7%) and 8 (5.6%), respectively. The least was below elbow amputation 6 (4.2%). The study showed that 96% of the causes were potentially preventable, and that establishment of a prosthetic-orthotic center is needed in this part of the country.

Telescopic removal of bullet in a challenging case of gunshot injury

Telescopic removal of bullet in a challenging case of gunshot injury

Review of 166 Gunshot Injury Cases in Dogs

The study is aimed to establish predilection signalment and history data, and to investigate clinical findings and risk factors associated with a poor outcome in dogs with projectile injuries. A retrospective study was undertaken of 166 canine cases in which a projectile was found on radiograph in a university׳s diagnostic imaging center more than a 4-year period. The study included dogs with both apparent (obvious recent traumatic event) and incidental (traumatic event unknown to the owner) projectile injury. Radiographs were reviewed and data regarding projectile position according to body region, number and type of projectile(s), bone fracture(s), and wound(s) related to projectile were recorded. The dogs were divided into groups according to owner address, hunting accident vs. shooting unrelated to hunting, and projectile type found on radiographs. Overall, 160 dogs met the inclusion criteria, making 0.76% the incidence of gunshot injuries. Further, 91 dogs were received with incidental projectile injury, and 75 dogs had apparent projectile injury. Male dogs were overrepresented (74.1%). Hunting accidents were the cause of projectile injury in 12.7% of cases. Fractures were observed in 20.5% of dogs. Most of the dogs (62%) were from an urban area, and the most common projectile type was airgun projectile (62%). The risk of fatal outcome was 14.4 times higher in dogs with thoracic injuries. Projectile injuries are still a real cause of trauma, especially in urban areas and in male dogs. Most gunshot injuries do not cause fatalities, although the thoracic projectile injury was associated with a greater fatality risk.

CEUS in gunshot wound of the liver – first experience in military mission

Purpose Computed tomography (CT) is the gold standard technique in gunshot injuries imaging. In military missions and in case of mass casualties availability of CT scanning and capacity of airborne transporting may be limited. FAST (Focused Assessment with Sonography in Trauma) remains the primary imaging examination in abdominal trauma. Contrast-enhanced ultrasound (CEUS) could close the diagnostic gap between CT scanning and FAST and back-up shortage of diagnostic avail- abilities. Material and methods We report a case of gunshot wound of the liver during military mission in Afghanistan. FAST and CT scanning were done as first diagnostic imaging. CEUS was performed additionally in the emergency room by CX 50 Philips ultrasoundsystem and SonoVue contrast agent. CEUS was repeated after each following operation and also done intraoperative to estimate the damage of the liver and hematoma. Results The wound track extension of traumatic gunshot wound could not be estimated on first CEUS examination due to aerodermectasia and gas echo extended along the wound track. Subsequent CEUS after first operations revealed that the wound track echo was unenhanced in majority. CEUS effectively detected the wound tract, hematoma, and the liver area injured by the gunshot and could accurately reveal necrotic tissue in the injured area and differentiate it from normal tissue. Conclusions Application of CEUS may provide important imaging for gunshot wound debridement in its follow up and avoid repeated CT scannings. Thus may spare time and transport capacity in millitary missions. CEUS is an interesting diagnostic tool in blunt and gunshot trauma of the abdomen.

Management of gun shot injury in a tertiary hospital

Introduction: Gun shot injury is an uncommon surgical emergency . A timely and multidisciplinary management by surgical team is an essential factor in decreasing mortality and morbidity . This study highlights the multidisciplinary management of gun shot injury.Methodology: Bir hospital is a postgraduate teaching hospital under National Academy of Medical Sciences and tertiary referral center in Kathmandu. A prospective cohort study of gunshot injury was conducted during Septemeber 2015 and early outcome analysis was done.Results: There were thirteen cases of gunshot wound. The mean age of casualty was 31 years and all were male.Injury Number (n) Intervention Outcome Large intestine 3 Laparotomy Ileostomy/wound infection Perineum 1 Exploration/Debridement Loop ileostomy Bone- fracture 3 Traction/Enternal fixation/ Open reduction Internal Fixation Vertebra 1 Right hip power 3/5 Vascular- AV fistula 1 stenting Referred Brachial plexus 1 Sensory/motor deficit Neck 2 Exploration Marginal mandibular nerve palsy Elbow 1 Debridement/Split thickness skin graftThere were no mortality and one case was referred.Discussion: With the multidisciplinary team approach, all the gunshot injury cases were managed with good outcome. The timely intervention by a surgical team is an essential factor for proper management of gun shot injury.

DIAGNOSIS OF GUNSHOT WOUNDS OF THE NECK AT THE CIVILIAN POPULATION IN THE CONDITIONS OF THE LOCAL MILITARY CONFLICT BY FORCES OF CIVIL HEALTH CARE

The retrospective analysis of 129 cases of gunshot wounds of a neck is the basis for research. The age of wounded varied from 18 to 65 years. All patients were on treatment in a surgical hospital of city hospital No. 9 of Grozny of the Chechen republic. All wounds have been got during local military operations in the Republic of Chechnya during the period from 1991 to 2000. As a result of the conducted research it is established that most of victims at the time of receipt had medium-weight severity. Most of patients – 67 (51,9%) at the time of receipt had heavy damages, damages of moderate severity have been revealed at 34 (26,3%) the wounded, small damages are noted at 12 (9,3%) victims, critical condition is noted at 9 (6,9%) patients and extremely heavy damages at 7 (5,4%) wounded. Difficulties of diagnostics, complexity of work of crew on duty, working in the conditions of military operations, lack of the diagnostic equipment and specialized crews, undoubtedly, led to diagnostic mistakes. So, when carrying out the retrospective analysis it is established that from 129 necks which have arrived with gunshot wounds, diagnostic mistakes have been noted at 58 (44,9%) wounded. In most cases – 34 (26,3%) diagnostic mistakes have been revealed at patients with wounds of internals that has led to development of complications and lethal outcomes, still in 19 (14,7%) supervision diagnostic mistakes were at wounded with wounds of vessels that has been connected with the stopped bleeding or existence of an alien subject which carried out a tampon role. In the others 5 (3,8%) diagnostic mistakes were at patients with soft tissues of a neck, at the same time the wound channel hasn’t been estimated.

Trauma Pattern in a Level I East-European Trauma Centre

Objective: To analyze trauma epidemiology, pattern of lesions or death profile in a level I east-European trauma center. Methods: Prospective observational study of patients admitted to a level I east-European trauma center and enrolled in our trauma registry, between January 2012 to January 2013, was conducted, with the inclusion criteria: (1) trauma lesions, (2) new injury severity score (NISS) higher than 15. Results: There were 141 patients admitted during the study interval, including 102 (72.3%) males, with a mean age of (43.52 ± 19.00) years, and a mean NISS of 27.58 ± 11.32. The trauma etiology was traffic-related injuries 101 (71.6%), falls 28 (19.9%) and crushing injuries 7 (5.0%). Only one case of gunshot wound was encountered in our study. Out of traffic-related injuries, the automobiles were involved in 56 (55.4%) and motorcycles in 9 (8.9%) patients. The bicyclists accounted for 2 (2.0%) of patients and pedestrians hit by vehicles were in 33 (32.7%) cases. High-velocity falls were found in 7 (25.0%) patients, whereas low-velocity falls accounted for 21 (75.0%) of cases. The overall mortality was 30.00%, and these patients presented the mean NISS of 37.63. Our trauma pattern profile is similar to the one found in west-European countries, with a predominance of traffic-related injuries and falls. The severity and anatomical puzzle for trauma lesions were more complex secondary to motorcycle or bicycle-to-auto vehicles collisions. A trauma registry, with prospective enrollment of patients, is a very effective tool for constant improvements in trauma care.

Civilian Gunshot Injuries: Experience from Sokoto, North-West, Nigeria

Introduction: The Proliferation of small arms in the West African sub-region and the activities of insurgent groups and rustlers have caused renewed interest in Gunshot injuries. We aim to document the trend and outcome of such injuries in our sub-region. Methods: It was a prospective study of cases of gunshot injuries admitted at the University Teaching hospital over a period of 18 months. Parameters analysed included patients’ bio-data, region of the body affected, mechanism and source of projectile, clinical presentations and short term outcome. Statistical analysis was done with IBM SPSS 20. Level of significance was p<0.05. Results: A total of 43 patients were seen with a mean age of 33.76 ± 10.59. There were 42(97.7%) males and 1(2.3%) female. The victims were mostly farmers (25%), professional drivers (13.6%), Students (11.4%). The body region affected were the lower extremity (36.4%), upper extremity (27.3%), Most of the cases were from armed robbery attack (77.3%) and Assaults (13.6%). Low velocity weapons like Dane guns were the common sources of projectile 95.3%. High velocity weapon like AK 47 was used in 4.7% of cases. Majority of victims were shot at closed range (86.4%) and 79.5% were stable on presentation. Intervention carried out included wound debridement (65.9%), external fixation (23%), and chest tube drainage (9.1%). The outcome was such that 68.2% survived without residual deficit while 31.8% survived with residual deficit. Conclusion: Gunshot injuries were mainly from armed robbery attack using low velocity weapon with farmers being the most victims. Strict regulations in the acquisition and use of light firearms would reduce the incidence of armed robbery and gun related violence in our sub region.

Emerging Trends of Intentional Firearm Injuries in Northern India: A Study.

Many developing countries are facing rise in firearm injury cases owing to communal and ethnic clashes, political violence, armed robberies and suicide causing huge economic loss to society. On the basis of intention, injuries can be categorized as intentional and unintentional or accidental injuries. Intentional injuries will include suicidal, homicidal and assault related injuries. This study was undertaken to document the trends and patterns associated with intentional firearm injuries in order to suggest ways to curb the emerging trends. This was a cross-sectional and descriptive study conducted at Jawaharlal Nehru Medical College and Hospital (JNMCH), AMU, Aligarh, UP, India from May 2007 to April 2008. The parameters studied were month wise distribution of cases, age and sex distribution of victims of intentional gunshot injuries, body part injured, alleged assailant and medical management provided to the victim. The observed data was entered onto a worksheet and descriptive statistics were used. A total of 140 cases of intentional firearm injuries were studied, 133 were assault cases and 7 were suicide by means of firearm. Maximum number of intentional gunshot injury cases were reported during the month of September (17.14%) and October (14.29%) and least during month of December (2.14%). For intentional injuries, 21-40 years was the high risk age group (91 or 65% cases) with male preponderance (95.71%) and male to female ratio of 22:1. Preferred site for assault was the trunk, with 50.38% cases with chest abdomen and back injuries. Family feud (20.71%) was the leading cause of assault and assailant was not known (47.86%) to the victim in majority of cases of assault injuries. Increasing cases of firearms as a means of assault and suicide, calls for limiting the number of handgun purchase, regulations to check illegal trade of firearms, accountability of ammunition used and to develop standardised hospital based data collection system so that trend and patterns associated with intentional firearm injuries can be determined.

СASE OF NONPERFORATING NONLETHAL WOUND OF THE HEAD, CAUSED BY CHILD’S OWN HANDS

Case of gunshot wound in head of 3 years old boy caused by nonlethal pistol PB–4 “Wasp” described in this article. Bullet retained in skull cavity and doctors decided not to disturb it for avoiding sever complications. There are no serious dysfunction’s in general, neurological and mental status 9 months later after the incident.

Gunshot wound without entrance hole: where is the trick? - a case report and review of the literaturer.

The presence at CT scan of more retained bullets than expected could be a very difficult interpretation challenge in the early management of gunshot wounds. The modern non operative management of haemodinamically stable patients without peritonitis requires that the trajectory of the bullet is clearly recognized. This clinical case reporting of a gunshot wound without evident entry hole, allows to discuss the diagnostic and therapeutic implications in the management of gunshot wounds cases with atypical entry and/or exit holes.