Abstract
We report a case of 30-year-old-male who was transferred to our center because of thoracic and abdominal gun shot wounds (left edge of the sternal manubrium and right superior anterior ileac spine). Consciousness level of the patient was clear and an echocardiography showed no pericardial fluid collection, but he presented the signs of shock (blood pressure 56/33, pulse rate 129/m, respiratory rate 36/m). After insertion of a right thoracic tube drainage, an emergency operation was performed 18 minutes after admission and 32 minutes after the event. We found no abnormality in the mediastinum and pericardium, but found sternal fracture, right internal thoracic arterial injury and lung injury under median sternotomy, and performed ligation of the injured artery. During laparotomy we found caecal injury and sigmoid colonic mesenteric injury, and performed simple closure and suture of these injuries. We also found active hemorrhage from the presacral venous plexus, and thought it was difficult to control and performed gauze packing. After 43 hours from the first operation, the packed gauze was removed. The patient was discharged on the 35th hospital day. Although we seldom encounter patient with gun shot wound in Japan, they often require emergency treatment for massive hemorrhage or lethal organ injury. We should continue a close evaluation of the patient's condition during the emergency operation and should change the treatment strategy to damage control if necessary.
