Presentation
Admitted to the emergency department as he had a gun shot injury.
Patient Data
A multiplanar reformatting CT scan; mediastinal and lung windows showing herniated bowel loops through diaphragmatic defect with collapsed left lung and mediastinal shift to the right.
The bullet penetrates the lateral aspect of the left 8th rib and the posterior aspect of the left 11th rib settle in the soft tissue of the back against the D12 vertebra.
Selected annotated images from the sagittal and coronal reformatting scan shows the free diaphragmatic ends (red arrows head ) and the herniated bowel lobe through the diaphragmatic defect (blue arrows).
Case Discussion
This patient was attacked by a gun shooter, the bullet had ruptured the diaphragm and settled in the soft tissues of the back.