A CASE OF A 29-YEAR-OLD MALE WITH MULTIPLE GUNSHOT jaziaabdurajak@gmail.com

PE107

A CASE OF A 29-YEAR-OLD MALE WITH MULTIPLE GUNSHOT

3

 

 

 

 

Philippines

Oral or Poster

Penetrating thoracoabdominal injuries, especially those involving the cardiac box, pose complex diagnostic and management challenges due to the potential for damage to vital thoracic and abdominal structures. The cardiac box is anatomically defined by the clavicles superiorly, costal margins inferiorly, and midclavicular lines laterally, and it contains critical organs including the heart, lungs, and great vessels. Injuries in this region warrant a high index of suspicion for intrathoracic and diaphragmatic involvement (1,2). The initial management of such trauma is primarily dictated by the patient's hemodynamic status and the presumed trajectory of the projectile. Hemodynamically unstable patients with signs of cardiac tamponade, tension pneumothorax, or massive hemothorax often necessitate emergent surgical exploration. Conversely, stable patients benefit from detailed diagnostic imaging such as focused assessment with sonography for trauma (FAST) and computed tomography (CT) to evaluate injury extent and guide appropriate intervention (2,3). This report presents a unique case of multiple penetrating gunshot wounds to the anterior trunk, including the cardiac box, resulting in isolated intra- abdominal and retroperitoneal injuries without thoracic or diaphragmatic damage. The case highlights the importance of a tailored approach in thoracoabdominal trauma and adheres to the SCARE 2023 case report guidelines (1–5)

A stable male patient with a cardiac box entry wound underwent trauma ultrasound and exploratory laparotomy to assess injury extent and guide management.

Intra-abdominal injuries were identified and surgically addressed. No thoracic or diaphragmatic involvement was found. The patient recovered uneventfully.

This case highlights the importance of a thorough and systematic approach in managing penetrating trauma, particularly when the injury involves anatomically complex regions such as the cardiac box. Despite the presence of a thoracic entry wound, focused clinical assessment and bedside imaging allowed for the safe exclusion of intrathoracic and diaphragmatic injuries, enabling timely surgical management of extensive intra- abdominal and retroperitoneal trauma. While the absence of preoperative CT imaging presented a diagnostic limitation, critical use of point-of-care cardiac ultrasound and sound clinical judgment ensured appropriate operative decision-making. Adherence to damage control principles facilitated patient stabilization and recovery. This case reinforces the value of multidisciplinary coordination and individualized surgical strategies tailored to the clinical context and mechanism of injury. It also underscores that not all cardiac box injuries mandate thoracic exploration, especially in hemodynamically stable patients with reliable bedside imaging. Continued emphasis on trauma protocols, targeted diagnostics, and interdepartmental collaboration will further enhance outcomes in similar high-stakes scenarios—even in resource-constrained settings.