Taking a detailed and thorough history of the patient may guide potential management. The history of a penetrating abdominal trauma during the initial presentation of the patient to the emergency department is crucial to providing clues to the pattern of injury. The male age group of 20–24 years old is notably the most affected by firearm injury. Males disproportionately bear the burden of firearm mortality, accounting for 86% of all victims of firearm death. Also, it is notable that non-Hispanic whites and non-Hispanic American Indian/Alaskan natives account for the majority of suicides related to firearms. Young adults between the ages of 25 and 34 years have the highest rate of fatal firearm injury and approximately 90% of patients are males. The homicide rate is 7 fold higher in Black males than any other demographic. Racial disparities in firearm-related homicide and suicide do exist. In a study completed from 2010 to 2012, almost half of all firearm deaths in the United States occurred in the South and were lowest in the Northeast region. Internationally, war-inflicted countries have increased the incidence of gunshot abdominal injury due to more firearms being available. Overall, firearm injuries are ranked among the 5 leading causes of death for people ages 1 to 64 in the United States. Firearm suicide is the third leading cause of injury death for persons aged 35 years and older, after drug overdoses and motor vehicle crashes. Firearm homicide is the second leading cause of injury death among youth 10 to 24 years of age. In an emergency setting, many patients with abdominal gunshot wounds may be taken immediately to surgery for diagnostic evaluation and treatment of injuries.įirearm-related deaths are the third leading cause of trauma-related deaths in the United States today. In an average week, 645 people lose their lives to firearm violence and 1565 more are treated in an emergency department for a firearm-related injury. Health care professionals may choose to order X-rays and other rapid imaging to quickly identify the location of the foreign object or bullet and plan early goal-directed management. In addition to the physical exam, an emergency assessment may include a FAST (Focused Assessment with Sonography in Trauma) to rule out hemoperitoneum. Ī mainstay of care for a potentially penetrating gunshot wound to the abdomen is emergency evaluation and often emergency surgical consultation is required to rule out acute abdomen, prevent exsanguination, and decrease the likelihood of developing peritonitis and sepsis. Many abdominal gunshot wounds result in penetrating trauma. If there is an exit wound that accompanies the entry wound, this may be considered a perforating abdominal wound. If the projectile enters the body, it is considered a penetrating injury. A penetrating gunshot abdominal injury can result in the foreign object remaining in soft tissue compartments or finding an exit pathway out of the body. This may include soft tissue structures only but may also include damage to bone, vasculature, and internal organs. A projectile from a firearm will enter the skin and layers of tissue and inflict damage to anything in its pathway. Penetrating trauma due to gunshot results from a firearm and can lead to multisystem organ injury, shock, and infection. Although direct abdominal trauma may be caused by a penetrating bullet, there may be shrapnel or fragmentation from the bullets that can disperse into the intra-abdominal cavity also causing injury. Also, the liver and intraabdominal vasculature are oftentimes injured as well at 40% and 30% involvement, respectively. The most common organs injured are the small and large bowel at 50% and 40%, respectively. In gunshot wounds, due to the high-intensity kinetic energy of the bullet, the pathway is often unpredictable in nature as well as the internal organs that may be affected. The most common cause of a penetrating abdominal injury is a stab wound or gunshot wound. While the leading cause of blunt abdominal trauma-related deaths in the United States in adults ages 15 to 24 is due to motor vehicle collisions, abdominal gunshot wounds account for up to 90 percent of the mortality associated with penetrating abdominal injuries. Gunshot wounds in the abdominal region can range from minor wounds to severe traumatic injuries depending on the anatomical structures the bullet penetrates. Traumatic injuries to the abdomen can result from a wide range of etiologies and can lead to life-threatening injuries, multi-organ system dysfunction, and death.
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