Abstract
Gunshot wound victims have been rarely seen in Japan due to the strict laws against owning guns, and the lack of related crimes. Therefore, the treatment strategy for patients with gunshot injuries has not fully been established. Considering the increase in gun-related homicides and an unstable international situation leading to war and terrorism, emergency surgeons should be trained to try and prevent a ‘preventable death’ as a result of gunshot injuries. As part of this, surgeons should be familiar with ballistics, practical gunshot wound management, and the possibility of delayed lead poisoning associated with residual bullets. A 53-year-old man was brought into the hospital by ambulance because he was accidentally hit in the left side of his abdomen by a shotgun blast while he was hunting. On admission, abdominal X-ray films and CT revealed a bullet and its fragments in the left lower abdominal wall. We performed local debridement, irrigation of the entrance, and removement of the bullet and its fragments as well as diagnostic laparotomy. The patient was discharged from our hospital on the 9th postoperative day and his postoperative course was uneventful. In the management of abdominal gunshot injuries, prompt diagnosis and evaluation of organ injuries in minimum invasive procedure are mandatory, and removal of the bullet should be performed as soon as possible when considering the possibility of delayed lead poisoning.
