What is Abdominal Gunshot Wounds?
Traumatic injuries to the abdomen can come from many sources and can cause serious harm, multiple organ failure, and even death. Gunshot wounds in the abdomen can be mild or severe, depending on which body parts the bullet hits. The main cause of death from blunt abdominal trauma among young adults aged 15 to 24 in the United States is car accidents. However, abdominal gunshot wounds cause up to 90 percent of deaths from penetrating abdominal injuries.
Common causes of penetrating abdominal injuries are stabbings and gunshot wounds. Gunshot wounds can be unpredictable because the bullet’s high speed can affect various internal organs. The small and large intestines are the most frequently injured organs, with 50% and 40% respectively. The liver and blood vessels inside the abdomen can also often be damaged, at rates of 40% and 30% respectively. Direct abdominal injury can be caused by a penetrating bullet, but injury can also occur from bullet fragments that spread into the abdominal cavity.
What Causes Abdominal Gunshot Wounds?
Penetrating trauma from a gunshot can cause serious harm, damaging multiple organs, leading to shock, and increasing the risk of infection. When a bullet from a firearm enters the body, it can damage everything in its path, including skin, tissue, bone, blood vessels, and internal organs.
With a gunshot wound to the abdomen, the bullet might stay inside the body in the soft tissues, or it could exit the body creating another wound. If the bullet stays inside, it’s called a penetrating injury. If the bullet also comes out, creating an exit wound, it’s known as a perforating abdominal wound. Most gunshot wounds to the abdomen cause penetrating injuries.
When a person comes to the emergency room with a potential gunshot wound to the abdomen, healthcare professionals will do a quick check and often consult with a surgeon. The goal is to prevent life-threatening bleeding and to reduce the chances of developing an infection in the abdomen and bloodstream.
As well as a physical examination, the emergency team may use a technique called FAST (Focused Assessment with Sonography in Trauma) to check for blood in the abdomen. They might also order X-rays and other quick scans to find the bullet and plan the best way to manage the situation. In emergency situations, many patients with gunshot wounds to the abdomen may be taken straight to surgery for a closer look and to treat any injuries.
Risk Factors and Frequency for Abdominal Gunshot Wounds
In the United States, deaths due to firearms are the third top reason for trauma-related fatalities. Every week, firearm violence results in about 645 deaths and 1565 emergency department visits. It’s also a major issue among young people between the ages of 10 and 24, where it’s the second leading cause of injury-related deaths. For individuals who are 35 years or older, firearms are the third leading cause of injury-leading deaths, following drug overdoses and car accidents.
- Firearm injuries are in the top five causes of death for people between the ages of 1 to 64 in the United States.
- From 2010 to 2012, nearly half of all gun-related deaths in the US were in the South whereas the Northeast had the lowest.
- Countries with ongoing wars have seen a rise in gunshot abdominal injuries due to more accessible firearms.
There are significant differences in gun-related deaths based on race. Black males are seven times more likely to die from firearm-related homicide than any other group. However, firearm-related suicides are mainly carried out by non-Hispanic whites and non-Hispanic American Indian/Alaskan natives. Young adults, particularly those between 25 to 34 years of age, experience the highest rate of fatal firearm injuries. And, about 90% of those affected are men. Particularly, men between the age of 20 to 24 are the most impacted. Men, in general, account for an overwhelming 86% of all firearm-related deaths.
Signs and Symptoms of Abdominal Gunshot Wounds
When a patient arrives at the emergency department with a wound from abdominal trauma, it’s crucial to understand the details of how the injury occurred. Everything from the events leading up to the injury, the people involved, the patient’s medical history, medications, allergies, and any details about the weapon used or the number of shots can provide essential clues for medical treatment. Sometimes, these details might need to come from paramedics, police, or fire rescue, especially if the patient isn’t able to explain what happened. It’s also important to ensure security and law enforcement are involved for the safety of the care team until the full context of the injury is understood.
The physical exam is an important part of diagnosing trauma patients as the symptoms may not be obvious. The patient might report pain, bleeding, unstable vital signs, or signs of peritonitis. The doctor may find wounds, ecchymosis (a type of bruising), enlarged abdomen, absent bowel sounds, and distress when the abdomen is touched. If peritonitis is present, which is inflammation of the inner wall of the abdomen, the patient may show symptoms like abdominal stiffness, guarding (a reflex contraction of the abdomen muscles), and rebound tenderness (pain felt after the doctor stops pressing the examination fingers against the belly). Regular check-ups of the patient’s vital signs can help doctors monitor if the patient is in shock or if their condition is worsening. A thorough check for wounds is vital in patients with gunshot injuries to the abdomen.
Testing for Abdominal Gunshot Wounds
When examining a patient with a potential injury from trauma, doctors first focus on checking the patient’s airway, their breathing, and their blood circulation. The decision of whether an abdominal injury has occurred often depends on the patient’s immediate symptoms and their blood pressure and heart rate, which doctors refer to as ‘hemodynamic status’.
If the patient’s vital signs are stable and there are no signs of inflammation of the lining of the abdomen (peritonitis), a computed tomography (CT) scan can be done. This scan helps to find any free fluid in the abdominal cavity, any injuries to solid organs like the liver or kidneys, and any evidence of bleeding.
However, if the patient seems potentially unstable, and their condition might worsen rapidly, a certain type of ultrasound scan, known as the Extended Focused Assessment with Sonography for Trauma (EFAST), may be done immediately. This is a quick bedside scan for critically ill patients that focuses on finding any hemorrhages in the abdominal cavity. With experience, health professionals can quickly use this tool to identify potential problems in the chest and abdominal cavities.
The EFAST ultrasound looks at several specific areas:
1. The right upper area (RUQ), where injuries often cause blood to accumulate. This area contains the lower part of the right kidney, the space between the diaphragm and the liver (subphrenic space), the area between the liver and the right kidney (hepatorenal space or Morrison’s pouch), as well as the space around the lungs (pleural space).
2. The left upper area (LUQ), which includes the lower part of the left kidney, the subphrenic space, the area between the spleen and the left kidney (splenorenal space), and the pleural space.
3. The space just above the pubic bone (suprapubic space), which contains different structures based on the patient’s gender: in women, it contains the Pouch of Douglas while in men, it contains the Rectovesicle space.
4. The space just below the ribs (subcostal space), where doctors look for any blood accumulation around the heart.
5. The space around the lungs, to check for air or blood in this area (pneumothorax or hemothorax).
It’s important to note that if a patient has been shot in the abdomen, and shows signs of peritonitis or unstable vital signs, they should be taken to surgery immediately rather than waiting for any diagnostic testing.
Treatment Options for Abdominal Gunshot Wounds
When someone has been shot in the abdomen, first responders like paramedics are crucial in beginning immediate treatment. The steps they take can greatly impact the chances of the patient’s survival. Their primary responsibility is to secure the patient’s airway, ensure they are breathing, check circulation, and stop any bleeding. They must protect the neck if the type of injury suggests it could be at risk. It’s important to also check the patient’s breath sounds, as the injury may not be limited to just the abdomen.
Before arriving at the hospital, the medical team may apply pressure to the wound to help stop the bleeding. They could use anything from medical gauze to clothing items to do this. Although it’s rare for a tourniquet to be feasible for an abdominal gunshot wound, this could be an option if a professional is available. If the patient stops breathing or their heartbeat becomes undetectable, CPR should be done right away. If the patient’s condition becomes unstable, fluids should be provided promptly, and blood must be taken to match for a transfusion. If needed, an emergency transfusion of O negative blood might be employed due to its lower risk of causing harmful reactions. Some patients might require a large volume transfusion, if the facility allows for it.
Anyone with an abdominal gunshot wound who is bleeding internally, showing signs of peritonitis (an abdominal infection), or whose condition is deteriorating, must quickly undergo a potentially lifesaving surgery called laparotomy. Non-operative treatment is less invasive, but this will depend on the doctor’s determination, based on clinical and radiological findings. Some patients might need to be transferred to a facility capable of performing surgery. Medical teams might also consider giving the patient a tetanus shot, wide-ranging antibiotics, pain relievers, and calming medication.
After patients have achieved stability, they need to be closely observed to pick up on any changes in their vital signs. Medical staff should continually perform physical examinations, and conduct blood tests to track the patient’s recovery.
What else can Abdominal Gunshot Wounds be?
When first examining a person who has been injured, doctors must determine whether the injury has pierced the skin or not. For injuries that do pierce the skin, they’ll consider if they might be gunshot wounds, stab wounds, or other types of injuries that can break through the skin’s surface. Understanding what happened during the injury event can assist doctors in pinpointing the exact kind of penetrating wound to the abdomen.
What to expect with Abdominal Gunshot Wounds
The effectiveness of an early, goal-oriented treatment plan for abdominal gunshot wounds is critical. However, it mostly depends on the extent and severity of the injury and how quickly the patient arrives at the hospital. Standard treatment for such gunshot wounds involves supportive measures like controlling bleeding, giving blood transfusions, supporting heart and lung functions, and performing surgery on damaged internal organs. Surgeons also aim to remove any foreign objects. A timely surgical response can impact survival rates and complications. Regrettably, survival rates for abdominal gunshot wounds are still very high. This could be due to a number of factors such as the size of the bullet, how it moved in the body and how much energy it transferred to the impacted organs.
A study looked into trauma patients in Philadelphia who had penetrating injuries like stab or gunshot wounds. The study examined the survival rates from 2003 to 2007 of these patients in Philadelphia hospitals. The study found that of the 4,122 patients brought to eight high-level adult trauma centers, 2,961 came by emergency medical service and 1,161 by police. The overall survival rate was 27.4 percent. In this study, about 77.9% of these victims had gunshot wounds, and about 22.1% had stab wounds. About one-third of the patients with gunshot wounds did not survive, and around 7.7% died due to complications from stab wounds.
Possible Complications When Diagnosed with Abdominal Gunshot Wounds
Possible complications from abdominal surgery include:
- Excessive blood loss
- Incomplete fluid replacement
- Failure of the airway
- Peritonitis (inflammation of the abdomen lining)
- Intra-abdominal sepsis (abdominal infection)
- Fistula formation (abnormal connection between organs)
- Wound separation
- Blood clot under the skin (hematoma)
- Scarring
- Infection
- Possibility of death
Recovery from Abdominal Gunshot Wounds
The kind of care someone receives after surgery is determined by the injuries identified during the operation. Pain relief is a crucial part of this post-surgery care. It’s also important to start considering food intake as soon as possible when it’s appropriate. Preventing deep vein thrombosis, a condition where blood clots form in the veins, is another important factor in the care of patients after an abdominal gunshot wound surgery.
