Renal and colon trauma from gunshot

Case contributed by RMH Core Conditions

Presentation

Gun shot wound to left chest then hit by car. Positive FAST scan.

Patient Data

Age: 40
Gender: Male
CT

Abdomen/Pelvis

The metallic projectile traversed through the left upper quadrant, lacerated the upper pole of the left kidney with a moderate amount of urine leakage demonstrated on the delayed images. The resultant small urinoma was noted which appears predominantly contained within the Gerota's/Zuckerkandl's fascia and retro-colic space. However, undoubtedly the fascia is disturbed and communicating with the intraperitoneal cavity. Numerous locules of the free gas were identified within the peritoneal cavity as well as in the retroperitoneum and behind the left diaphragmatic crus. The projectile has eventually stopped adjacent to the left pedicle of L1, just above the intervertebral foramen, with a small psoas haematoma.

There are small locules of gas within the spinal canal, with an impression of increased segmental density anterior to the cord/dura. This could be due to beam hardening artefact and radicular vessels or intraspinal venous plexus; however, possible small epidural collection can not be definitely excluded and correlation with the neurological findings may be of help.

There is a small left para colic and LUQ intra peritoneal fluid which may be urine; however, proximal descending colon is asymmetrically thickened and given the course of the projectile, there is a strong suspicion for injury.

Mildly displaced right L1 & L2 transverse process fractures.

Bilateral inguinal hernias, the left containing unobstructed sigmoid colon. 

Case Discussion

Injuries in this case from penetrating trauma:

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Case information

rID: 26329
Case created: 13th Dec 2013
Last edited: 4th Jul 2017
Inclusion in quiz mode: Included

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