Well-placed ETT and NGT. Urinary bladder catheterised and partially voided.
No evidence of fracture, pneumothorax/pneumomediastinum, or lung contusion.
Bullet has entered via right anterior abdominal wall and exited via right posterior wall, piercing the liver between segments 8 and 5 and creating a tract through segments 5 and 6 (AAST grade IV injury). There is active extravasation of contrast media consistent with arterial haemorrhage.
Large amount of free intraperitoneal high-density fluid - blood.
Radiographic evidence of haemoglobinopathy:
- Surgical staples in left upper abdomen post-splenectomy.
- Osteoporotic axial skeleton shows widened medullae with prominent trabeculation and thin cortices.
- Bilateral paracostal-extrapleural, paraspinal, and presacral foci of extramedullary haematopoiesis throughout the chest.
- Mildly H-shaped vertebrae (sagittal view)