FREQUENCY , PATTERN AND OUTCOME OF GUT INJURIES IN ABDOMINAL FIREARM

1. FREQUENCY, PATTERN AND OUTCOMEOF GUT INJURIES
IN ABDOMINAL FIREARM
BY:
DR PIRAH KORAI
FCPS-ii Trainee
CMC Larkana

2. INTRODUCTION
 Firearm injury is one of the biggest national
and global issue we are facing now a days.
It is the leading cause of non-natural deaths
in our setup.
 Abdomen is the most commonly involved
part. Having a highest number of GUT
injuries.

3. METHODOLOGY
• STUDY DESIGN:
Prospective Descriptive study
• PLACE OF STUDY:
Surgical unit2,
CMC Teaching Hospital Larkana
• DURATION:
One year (from january 2014 to dec 2014)

4. • INCLUSION CRITERIA:
All firearm cases exclusively involving abdomen
• EXCLUSION CRITERIA:
While cases having concomitant injuries other than
abdominal site (e.g chest injuries, genital injuries etc)

5. NO: OF PATIENTS:
n=42

6. Serial
NO:
Questions Yes No
1. Age
2. Sex
3. Previous comorbidity (if yes then mention)
4. Timing from injury to arrival of patient to hospital:
i. Less than 4 hours
ii. More than 4 hours
5. Presentation of patient:
i. Pain
ii. Bleeding from wound site
iii. Vomiting
iv. Unconsciousness
v. Visible Loops
vi. Visible Omentum
6. Type of weapon:
i. Bullet injury
ii. Pellet injury
7. NO: of injuries/wounds
8. Site of injuries:
i. Right Hypochindrium
ii. Epigastrum
iii. Left Hypochondrium
iv. Right Lumbar region
v. Umbilicus
vi. Left Lumbar region
vii. Right iliac region
viii. Hypogastrum
ix. Left iliac region
Hospital record NO:

7. 9.
Detail of entry wound
i.
NO:
ii.
Size (in mm):
iii.
Site:
10.
Details of exit wound
i.
NO:
ii.
Size (in mm):
iii.
Site:
11.
Investigations:
i.
Xray findings:
3.
Air fluid levels
12.
Procedure details:
i.
Tract/wound exploration
ii.
Explorative Laprotomy
13.
Operative findings:
i.
Within normal limits
Ii.
Contamination/ collection
a.
Amount of collection
iii.
Hematoma
1.
Site of hematoma
2.
Type:
i.
Nonexpanding
ii.
Expanding
iv.
Injury to major blood vessels
v.
Perforation/injuries to organs
1.
Liver
2.
Spleen
3.
Gall bladder
4.
Diaphragm
5.
Pancreas
6.
Kidneys
i.
Left
ii.
Right

8. 7. Ureter
ii. Right/Left
8. Urinary bladder
9. Uterus
10. GUT:
i. Stomach
ii. Duodenum
iii. Jejunum
iv. Ileum
v. Caecum
vi. Ascending colon
vii. Transverse colon
viii. Descending colon
ix. Sigmoid colon
x. Rectum
14. Details of injury:
15. Operative procedure performed:
i. Left as such
ii. Primary repair
iii. Resection Anastomosis .
iv. Resection and stoma formation
v. Stoma types:
i. Jejunostomy
ii. Ileostomy
Iii. Colostomy
vi hemicolectomy
16. Post-operative follow-up
i. Condition improved
ii. Condition Deteriorated
iii. Referred to other departments
iv. Referred to other hospitals
v Death

10. Age of patients ranged from 10-60
years with a mean age of 25+/- 2 years

11. Males Females
85.70%
14.30%
36 were males and 6 were females

12. The timing from injury to arrival of patients to hospital was more
than 4 hours in 28 patients(66.6%).
66.60%

13. pain signs of
peritonitis
ALOC Visible
omentum/&
Loops
73.80%
23.80%
40.40%
7.14%
Clinical presentations vary from mere pain (31 patients), signs of
peritonitis (10 patients) to loss of consciousness (17 patients) and
visible omentum.

14. 64.20%,
35.70%
27 patients had pellet injury (64.20%) while 15 had bullet injury
(35.70%)

15. Regions having entry & / Exit
wounds
Region NO: of patients Percentage
Left Lumbar 9 21.4%
Right Iliac 9 21.4%
Epigastrum 8 19.09%
Right Lumbar 8 19.09%
umbilicus 8 19.09%
Right
Hypochondrium
7 16.6%
Left Hypochindrium 7 16.6%
Hypogastrum 3 7.14%
Left Iliac 2 4.7%

16. 35 patients (83.3%) underwent
explorative Laprotomy
83.30%

17. Out of them 4 (11.42%) were
having normal abdomen
11.42%

18. Out of these 35 explored patients,
29 had collection inside
17.20%
82.80%
No collection
collection
Amount range: 100 to 3000ml. (Averagely 1151.7ml)

19. Haematoma
37.10%
38.40%
61.60%
Haematoma
exp
non exp
13 patients (37.10%) had Haematoma, out of them 5
(38.40%) had expanding type

20. Non GUT Organs
injured
NO: of patients Percentage
Liver 4 out of 35 11.4%
Urinary Bladder 2 out of 35 5.71%
Diaphragm 2 out of 35 5.71%
Spleen 1 out of 35 2.85%
Pancrease 1 out of 35 2.85%
Kidneys 1 out of 35 2.85%
Uterus 1 out of 35 2.85%
Gall Bladder 0 out of 35 0%
Ureters 0 out of 35 0%

21. 29 patients (82.8% ) had GUT
injuries
82.80%

22. GUT injuries
0%
5%
10%
15%
20%
25%
30%
35%
2%
5.72%
31.40%
28.50%
14.20%
2.85%
14.20%
8.51%
11.42%
8.57%

23. Procedures performed
16.60%
40%
31.40%
11.40%
2.85%
58.80%
2.85% 2.85%

24. Post-operative follow-up
NO: of patients percentage
Condition improved 26 61.9%
Death 4 9.52%
Referred to i.c.u 3 7.14%
Referred to other wards 3 7.14%
Referred to karachi 2 5.7%

25. Variables Frequency of
firearm in delhi,
india
D.J Trauma Acute Care
Africa
Our study
NO: 452 984 42
M/F 389/63 - 36/6
Common Age - 30-45 27
Duration of
study
3 years 10 years 1 year
Study type Retrospective Retrospective Prospective
commonly
injured intra-
abdominal
Liver Stomach, liver Jejunum ileum
liver
Laprotomy 76.4% 68.7% 83.3%
Variables Frequency of
firearm in
delhi, india
D.J Trauma
Acute Care
Africa
Our study
NO: 452 984 42
M/F 389/63 - 36/6
Common Age - 30-45 27
Duration of
study
3 years 10 years 1 year
Study type Retrospective Retrospective Prospective
commonly
injured intra-
abdominal
Liver Stomach, liver Jejunum ileum
liver
Laprotomy 76.4% 68.7% 83.3%
COMPARISON WITH INTERNATIONAL
RESULTS

26. Conclusion
 The frequency of firearm injuries is alarmingly rising.
 The firearm injury is most common in young males
while the frequency in females is also increasing.
• In abdominal firearm injuries, the GUT particularly
small bowel is the most commonly involved part
followed by caecum and transverse colon.

27.  The prognosis and outcome largely depend upon timing
from injury to arrival of patient to hospital, level of
contamination and pattern of injuries.
 Morbidity and Mortality due to firearm injuries have
been appreciably improved.

28. • Because of unavailability of advanced radiologic setup
and diagnostic Laproscopy in Emergency departments the
frequency of negative abdomen is observable which
needs to be addressed.
• The root cause of unstable Law and order condition
should be addressed and properly dealt.