Gunshot injury to the abdomen

Case contributed by Dr Heather Pascoe


Gunshot wound to lower left chest then hit by a car.

Patient Data

Age: 80 years
Gender: Male

Abdomen and Pelvis


  • Bullet passes through the left 8-9th rib interspace and lodges abutting the left L1 pedicle.
  • It traverses the descending colon and left kidney (AAST Grade VI). Urine leak and collection in the anterior pararenal space.
  • Small left psoas hematoma.
  • Numerous locules of free gas in the peritoneal cavity, in the retroperitoneum and behind the left diaphragmatic crus.
  • Small locules of gas within the spinal canal.
  • No intraperitoneal fluid.
  • Mildly displaced right L1 and L2 transverse process fractures.
  • Fracture of the 12th rib which is hypoplastic.

Incidental findings:

Case Discussion

The aim of imaging of gunshot wounds is to: determine the path of the projectile/s; determine which tissues have been injured; estimate the severity of the injuries; identify any retained bullets and determine if any further investigations are required. Active hemorrhage must always be assessed for.

This case demonstrates how diaphragmatic injury can be inferred based on the trajectory of the bullet and the presence of blood on both sides of the diaphragm.


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Case information

rID: 32866
Published: 9th Feb 2018
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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