TITLE:
Assessment of Extent and Severity of Pellet Induced Abdominal Injuries, a Rare Variant of Weapon Violence: A Prospective Study
AUTHORS:
Azher Mushtaq, Atif Naeem Raja, Hilal Ahmad Wani, Shaukat A. Jeelani, Nazia Hilal, Ishfaq Ahmed Gilkar
KEYWORDS:
Pellets, Bowel Perforation, Laparotomy
JOURNAL NAME:
Surgical Science,
Vol.7 No.10,
October
19,
2016
ABSTRACT: Background: The use of a Pellet gun, a form of short gun used for mob control in many conflict zones, has posed a serious challenge to the surgeons in assessing the extent of
trauma caused by these pellets. Objectives: To study the role of conventional
available investigations for trauma like ultrasonography and computed
tomography scans in assessing the severity of the injuries caused by the
pellets. Methodology: 50 patients having pellet injuries predominantly in
abdomen without other associated trauma were included in the study. The
decision for surgery was taken on the basis of clinical and CECT (Contrast
Enhanced Computed Tomography) findings and these findings were then compared
with intra-operative findings. Results: 30/50 patients were decided to be
operated on the basis of Clinical and CECT findings. On exploration, it was
observed that 18/33 patients really needed exploration while as 15/33 patients
could have been managed conservatively. This was observed in next 20/50 patients
who were put on conservative management with similar CECT findings. Of these 20
patients, 17 did well while as 3 were explored later in view of developing peritonitis
and were found to have small bowel perforations. Conclusion: Conventional
investigations for trauma like FAST and CECT abdomen are not ideal for
assessing the severity of pellet induced abdominal visceral injuries which
result in high rate of unnecessary laparotomies. Also the abdominal pellet
trauma patients can be well managed conservatively until hemodynamically stable
even though CT scan shows pellet penetration into peritoneal cavity or bowel
lumen.