Case Report

A 65 year old retied police officer presented in the Accident and Emergency of a State Specialist Hospital in one of Nigerian State capitals with one hour history of gunshot injury to the chest and abdomen. He was accidentally shot by his junior brother who is a senior security officer and who was solemnizing his wedding with his wife traditionally after leaving together for 25years! He presented with severe pain, massive haematemesis, evisceration of the omentum and active bleeding from entry and exit wounds in the 11 ^th left intercostals space along the posterior axillary line and left hypochondrial region respectively and was also in shock.

He had nasogastric tube passed, catheterized and resuscitated with intravenous fluid. The packed cell volume was 19% and transfused with two pints of blood in the Accident and Emergency room. He had left pneumohaemothorax which was confirmed radiologically.

Subsequently he had exploratory laparatomy within one hour of presenting in the hospital.

Findings

1. A small entry point at the 11 th left intercostal space along posterior axillary line and of about 1cm in diameter

2. A large exit of about 5cm diameter in left hypochondrial region plugged by omentun

3. Haemoperitonium of about 1.5L

4. Shattered spleen

5. A perforation at the greater curvature of the stomach about 1 cm in diameter with blood in the lesser sac

6. A centimeter perforation of the spleenic flexure of the descending colon. No obvious faecal contamination

7. A larger perforation of the jujenum involving about 50% of the circumferential wall.

8. The diaphragm and the liver were essentially normal

Surgical Procedures

The patient had exploratory laparatomy, splenectomy, closure of the perforations in the stomach and the large intestine. Intestinal resection and anastomosis was carried out on the small intestine perforation.

A chest tube was inserted at the 7 ^th intercostal space along mid axillary line for the pneumohaemothorax and about 500ml of altered blood was drained. Thorough peritoneal larvage was done, drain inserted and wound closed. He was transfused with 3 ^rd pint of blood postoperatively and was on parental antibiotics, metronidazole and ciprofloxacin for 5 days.

He was stable postoperatively and the bowel sound returned on the 5 ^th day of post surgery when he was commenced on graded oral fluid. On the 6 ^th post operative day he became dyspneic and was in shock and died in the early hour of the 7 ^th post operative day.

Discussion

People often celebrate by firing guns into the air without realizing that this can cause serious injury or death. ₂ Bullets fired into the air during celebrations fall with sufficient force to cause injury and death. ₁ The mortality rate is significantly higher than for all gunshot wound victims in general because the patients are usually hit in the head. ₂ The injuries could also be caused by the bullet hitting the causality directly as showed in this case report. Events are often celebrated with fireworks and bonfire. Salutatory gunshots are often restricted to military celebration. In Nigeria especially in the western part guns could be fired during celebrations like burial, coronation and chieftaincy, wedding, traditional festivals, hunters' festivals, victory in political elections, and at political gathering. Gun shots are also fired during Christmas and New Year celebrations. In Puerto Rico, where Christmas and New Year celebrations are common, news media reports have indicated that approximately two persons die and an estimated 25 more are injured each year from celebratory gunfire on New Year's Eve. ₁

In this case presentation the injuries sustained by the patient were multiple and severe.

Review of electronic and english literature in our environment did not show any report of death from celebratory gunshot injuries thus this report. To prevent these avoidable injuries and death, gunshots should be totally be discouraged during celebrations. Life bullet should not be used where gunshots must be fired as part of the celebrations and the shooting must be directed away from the gatherings. Gun carrying security agents should be adequately trained about how to handle guns among the crowd. Other measure to prevent these injuries and death is to educate the populace about the untold danger of firing guns during celebrations especially where there is a crowd and laws should be enacted and enforced to prevent these serious and preventable injuries and death.

Correspondence to

Dr JD Ogunlusi FMCS (Ortho) Consultant Accident and Emergency / Orthopaedic Surgeon & Traumatologist, Victoria Hospital, Castries. St Lucia. West Indies. E mail: gbemidare@yahoo.com Phone no: +17587192605 Fax no: +1758 453 0960