1. MANAGEMENT OF GUN SHOT
WOUND OF ABDOMEN

2. Mr. S.A.H. a Somali national, aged 26 was
brought to ER at 00.10 AM/13/01/1432
with Gun shot(bullet) Injury at right gluteal
region.
He was shot by some one 2 hours before.
Patient complained of Pain right side of
abdomen/ No vomiting/No haematuria

3. Fully conscious and alert
Pulse:74, BP:140/80, R/R: 20, O2 Sat:
100%
LOCAL EXAMINATION: Entry wound Right
Gluteal Region, little oozing of blood from
the wound. NO EXIT WOUND.
CHEST: air entry present both side, equal,
no evidence of pneumo or Hemothorax.No
surgical emphysema.

4. ABDOMEN: Soft, no muscle guarding, no
distension, tenderness present over right
side of abdomen, Bullet was palpable in
right abdominal wall. Left half of the
abdomen completely normal. Normal
bowel sound.
No bleeding per Rectum or urethra.
CNS: fully conscious & alert, GCS:15/15,
no neurological deficit.

5. GUN SHOT WOUND RIGHT
GLUTEAL REGION/BULLET
LODGED IN ANT.ABDOMINAL
WALL . TO RULE OUT
INTRA ABDOMEN INJURY
(HOLLOW VISCUS INJURY)

6. XRAY CHEST ERECT: No air under
diaphragm
XRAY ABDOMEN: Bullet was seen 2 cms.
Above the Iliac crest (R). A hole about one
cm in diamater was seen in upper part of
iliac bone.
URGENT U/S ABDOMEN : No free fluid in
abdomen. No evidence of any solid viscus
injury.

11. Hb; 15.7, WBC: 8.8,
RBS: 128, CREA: 0.6
AST:67, ALT:25
ALP:50 BIL(T):0.9 (D):0.3
GTT:27 AMYL:63

12. The case was admitted , to be
under close observation and to do
double contrast CT abdomen.
TREATMENT ORDERED:
NPO/IV FLUIDS/IV
ANTIBIOTICS/REPEATED
EXAMINATION OF ABDOMEN.

13. Fully conscious alert
Mild pain abdomen at the site of bullet.
No vomitting/ No fever
Pulse:74, BP: 120/90, Temp: 37
Abdomen: Soft, No Distension, Tenderness
right side of abdomen at the site of
lodgment of bullet.No rigidity/No rebound
tenderness/Normal bowel sound.

14.  Patient was given to drink about one litre of
water mixed with gastrografin.
 Patient was examined again at 12.40PM.
 Pain abdomen has increased /vomited
once/No fever
 Vitals: Normal
 ABDOMEN: Mild distension, Muscle guarding
present/ Tender/Rebound tenderness:??
Bowel sound +
 DIAGNOSIS: PERITONISM/PROCEED FOR
URGENT EXPLOR.LAPAROTOMY(AFTER
CT ABDOMEN)

15. • PNEUMOPERITONEUM
• MILD AMOUNT OF FREE
FLUID
• HOLE IN ILIAC BONE(R)
• BULLET SEEN IN
ANT.ABD.WALL

21. TWO PERFORATIONS 1cm, each in
sigmoid colon , piercing the posterior wall
first ,then ant.wall of the colon. Bullet
lodged in anterior abdominal wall. Little
blood stained discharge in peritoneal
cavity.
RETROPERITONEAL HEMATOMA.
1CM TEAR IN POSTERIOR
PERITONEUM JUST 5MM BELOW
CECUM.

22. Perforations were closed primarily in
two layers using 3/0 prolene.
Peritoneal toilet was done & Abdomen
was closed in layers after insertions of
two drains one in abdominal cavity
and one in pelvis.
Patient was put on IV antibiotics and
flagyl.

23. Patient started improving gradually.
Passed flatus on 15/01/1432, started oral
sips of water and fruit juice.
Remained on fluid diet till 18/01/32.
Started soft diet on 19th then normal diet.
All sutures were removed on 23/01/32.
Patient was discharged same day.

24. THANK YOU