DECEPTIVE TRAJECTORIES: MANAGING COMPLEX THORACOABDOMINAL GUNSHOT INJURIES monica_ma_22@hotmail.com

PE112

DECEPTIVE TRAJECTORIES: MANAGING COMPLEX THORACOABDOMINAL GUNSHOT INJURIES

5

 

 

 

 

Portugal

Oral or Poster

Penetrating thoracoabdominal trauma from gunshot wounds can result in complex injury patterns involving multiple organ systems. Prompt recognition, stabilization of the patient and surgical management are essential to optimize patient outcomes.

We report the case of a 16-year-old male presenting to the trauma center after a gunshot wound, with an entry point on the left lateral thoracic wall and an exit wound at the sternal region. On arrival, the patient was hemodynamically stable and fully conscious. Initial management followed Advanced Trauma Life Support (ATLS) principles, including placement a left chest tube with exit of a significant amount of blood. Chest CT revealed a hemothorax without clear intrathoracic injuries.

The patient underwent an emergency thoracotomy, which revealed a massive hemothorax but no significant lesions of intrathoracic organs. Due to suspicion of intra-abdominal bleeding, an exploratory laparotomy was performed, revealing two diaphragmatic perforations, splenic laceration, gastric and colonic perforation. A splenectomy and a colonic segmentar ressection were performed, and the diaphragmatic and gastric perforations were repaired primarily. The postoperative course was uneventful, and the patient was discharged with full recovery.

Multidisciplinary coordination and adherence to trauma protocols are critical for favorable outcomes. Thoracoabdominal gunshot wounds may follow misleading trajectories, with a higher burden of injury than initially apparent. Consequently, any ballistic trauma should prompt a heightened index of suspicion for injuries in less obvious anatomical regions. This vigilant approach facilitates timely diagnosis and definitive management, reducing the risk of missed injuries and improving overall outcomes.