Thoraco-Abdominal Penetrating Injury

Dr. Sarmad Hiwa Arif1st November 2011

Brief History & Physical Examination

An 18 year-old male presented with bullet injury from a hand gun to the chest & abdomen admitted on October, the 27th at 9:00 pm.

Inlet: the Rt. 6th intercostal space medial to the midclavicular line, impacted in subcutaneous tissue of the Rt. 11th intercostal space at posterior axillary line.

O/E: Conscious, in severe pain, PR=90, BP=110/80.Abdomen: Soft, tender Rt. Hypochondrium with

guarding.

X-Rays (on admission)

U/SAn ill-defined hyperechoic area seen in anterior

segment of right lobe of the liver, 38*33 mm in diameter with an anterior anechoic tract seen inside the lesion. (liver contusion with haematoma).

Normal pericardium.Mild Rt side pleural effusion.

Management:Rehydration done, triple antibiotic & ATS given, with

good pain control.Close monitoring done with hourly vital signs

checking + measurement of in put & out put.The patients condition was stable & steady at

hospital.

Vital Signs

CECT of AbdomenRt lobe, anterior inferior segment laceration along

bullet tract, with bullet arrest at Rt posterolateral abdominal wall, associated with mild Rt pleural effusion of mixed density (haemothorax), normal rest of liver paranchymal density.

CECT of Abdomen

Out come On 30th Oct afternoon the bullet extracted under local

anesthesia & wound debridement done for the inlet.On 31st Oct the patient discharged on oral antibiotics

& simple oral analgesics.

Out come On 30th Oct afternoon the bullet extracted under local

anesthesia & wound debridement done for the inlet.On 31st Oct the patient discharged on oral antibiotics

& simple oral analgesics.