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One bullet, five compartments: a transregional gunshot trajectory and the limits of operative intervention

Year: 2026

Type: article

Abstract: Gunshot wounds with transregional bullet trajectories present significant diagnostic and management challenges. We report the case of an 20-year-old male who sustained a single gunshot wound entering at the left angle of the mandible, traversing the neck with injury to the thyroid cartilage, ricocheting off the right sternoclavicular joint and tracking through the right lung causing haemopneumothorax, before lodging in the perinephric fat adjacent to the right kidney. Pan-scan computed tomography (CT) was pivotal in delineating this complex trajectory. Management required a multidisciplinary approach involving Head & Neck surgery, Trauma surgery, Cardiothoracics, and Intensive Care. Diagnostic laparoscopy confirmed no peritoneal breach, supporting selective non-operative management (SNOM) of the retroperitoneal bullet. This case highlights the importance of thorough CT imaging from head to pelvis, the safety of SNOM for retroperitoneal bullets in stable patients, and the necessity of coordinated multidisciplinary surgical care for managing complex transregional gunshot injuries.

Source: Journal of Surgical Case Reports

DOI: 10.1093/jscr/rjag1026

Authors: Bianca Bachelet, Balaji Ravi, Hyerim Suh, Susmit Roy, Jeremy Hsu

Institutions: Westmead Hospital, Western Sydney University

Language: English

Topic: Trauma Management and Diagnosis

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,000