Penetrated sigmoid colon by air gun pellet could be life threatening: A case report

Abstract

INTRODUCTIONAir and paintball guns have been in existence for over 400 year. Although serious injury or death can result from the use of such guns, previous literature has not mentioned the issue of the penetration of the sigmoid colon by an air gun pellet.PRESENTATION OF CASEWe report a rare case of a 44-year-old Caucasian woman referred to abdominal surgery after an accidental small wound had occurred in the lower left abdominal quadrant that was caused by an air gun pellet. The blood and biochemical analyses were normal but the CT scan revealed the presence of a foreign body – an air gun pellet in the left iliac region of the abdomen. Clinically, during the initial 24 h significant changes were not noticed. After 42 h, however, pain and local tenderness in the lower left abdominal quadrant was expressed. A laparotomy revealed a retained pellet in the wall of the sigmoid colon and a small leak with colonic content with consecutive local peritonitis also occurred. The foreign body was removed and the opening edges in the colon were excised and closed with the primary suture.DISCUSSIONThe hollow organs of the digestive tract, albeit very rarely penetrated by an air gun pellet, do not typically show all signs of an acute abdomen in the early posttraumatic phase. Such injuries can lead to a pronounced infection, which may cause septic shock if not appropriately treated.CONCLUSIONFor correct diagnosis, a careful approach and several daily clinical observations are required.

Role of Laparoscopy in Abdominal Trauma

“…In our series twenty-eight patients with abdominal trauma, 22 penetrating trauma (78.57%), and 6 blunt trauma (21.43%). In penetrating trauma therapeutic laparoscopy for seven patients (31.8%) were (13%) in [7], diagnostic laparoscopy for 10 patients (45.5%) were (33%) in [7], and negative laparoscopy for 5 cases (22.7%) but was (11.5%) in [17]. Therapeutic laparoscopy were done for the following cases, two cases liver tears were hemostasis done by combined of cauterization and intra-corporeal stitching, three cases of diaphragmatic injury were repaired by intra-corporeal stitching, one cases of splenic tear were bleeding not stopped with cauterization and splenectomy done, last case was small bowel perforation were repaired with intra-corporeal stitching.…”

“…The advantage of laparoscopy can provide both diagnostic and therapeutic interventions for those hemodynamically stable abdominal trauma patients [6]. The solid organ and visceral injuries can be reliably assessed by laparoscopy, identification of intestinal injury is more challenging, however hollow organ injuries may display neither clinical signs of acute abdomen nor positive radiological signs in the early post-traumatic phase, subsequently delayed exploration with a higher risk of septic shock and increase morbidity ensue [7]. Laparoscopy can detect sign of visceral injury and repair it or convert to laparotomy [8].…”