Demographics:
35 years old, Male
Indication:
Gunshot wound to the abdomen
Findings
Lower chest
- Mild dependent atelectasis
Abdomen/Pelvis
- Wall thickening of the distal sigmoid colon with adjacent hemorrhage, more so along the right wall, and small volume pneumoperitoneum
- Short segment wall thickening of the terminal ileum with adjacent hemorrhage
- Contrast density focus in the ileocolic mesentery which increases in size on delayed images
- Small volume hemoperitoneum with a small amount of fluid extending into the left inguinal canal
- Colonic diverticulosis
- Bilateral renal subcentimeter hypoattenuating lesions, which are too small to characterize
MSK
- Acute, comminuted, minimally displaced right sacral fracture with involvement of the S3 and S4 neural foramina
- Adjacent small right piriformis intramuscular hematoma with a small focus of contrast density which becomes less conspicuous on delayed images
- Retained ballistic fragment in the lower left ventral abdominal wall just superficial to the rectus musculature
- Soft tissue contusion and subcutaneous gas in the right gluteal region
Diagnosis
Bowel injury
Sample Report
Findings are concerning for focal traumatic perforation of the distal sigmoid colon related to gunshot injury. Small volume associated hemopneumoperitoneum.
Likely additional site of injury and possible perforation involving the terminal ileum. Adjacent ileocolic mesenteric injury with a small area of active bleeding.
Right sacral fracture involving the right S3 and S4 neural foramina with an adjacent right piriformis intramuscular hematoma and small area of active hemorrhage.
Likely bullet entry site in the right gluteal region with retained ballistic fragment in the lower left ventral abdominal wall just superficial to the rectus musculature.
Discussion