A 58-year-old man presented to our hospital with an abdominal gunshot wound from point-blank range, and was admitted after 2.5 hours of being injured. He appeared pale, but conscious. Also, there were no signs of shock (blood pressure, 130/70 mmHg; pulse rate, 66 beats/min). There was a 40-mm diameter gunshot entry wound on the left side of the waist and four exit wounds on the right side of the abdominal area. Also, there were two bullets in the subcutaneous tissues on the right side of the abdominal area. He was paralyzed from the waist down. Computed tomography (CT) showed a wound track from the left waist to the right abdominal quadrant through the lumbar spine, resulting in a comminuted fracture. In addition, CT showed ascites and free air in the abdominal cavity. Eighty minutes after his arrival, he underwent surgery. We found a 1-point perforation of the duodenum, a 5-point perforation of the ileum, and amputation of the ileocolic artery. Fortunately, his major blood vessels were not injured. We performed an ileocecal resection along with simple closure of the duodenum and a gastrojejunostomy, followed by abdominal drainage. In addition, we removed the bullets from the right abdominal subcutaneous region. After irrigation, we closed the waist wound. Thereafter, on the 34th postoperative day he was referred to the orthopedic department of our hospital.
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