Bullet trajectory in a case of abdominal gun shot injury – causing descending colon perforation, left renal laceration with exit wound at posterior paraspinal L1 level

A focal defect  in the left anterolateral abdominal wall /chest wall apparently at 9-10 intercostal space – likely suggestive of *entry wound in given clinical settings of gunshot injury.

 Linearly oriented Hypo attenuating area  involving the left posterior paraspinal muscle at L1-L2 vertebral level extending up to the posterior paraspinal skin with evidence of small focal soft tissue emphysema at this level – possibility of this being and *exit wound cannot be ruled out.

 The left kidney appears diffusely hypodense with perinephric hematoma measuring 1.4 cm in maximum thickness.  evidence of focal defect involving the anterior as well as posterior cortex of left kidney at the lower pole – suggestive of ‘left renal deep laceration’ across entire cross section of the left kidney – apparently along the expected *trajectory (evaluation is grossly limited due to lack of IV contrast, the left renal vessels, collecting system, pelvis and ureter could not be evaluated due to lack of IV contrast).

 Marked pneumoperitoneum  predominantly involving bilateral subphrenic spaces and anterior non dependent peritoneal spaces (football sign)  with moderate to severe free fluid  in the abdomen and pelvis ( 40-50 HU) – suggestive of ‘hollow viscus perforation’.

 A small focal defect  in the anterior wall of left proximal descending colon– suggestive of  tramatic ‘perforation at the anterior wall of junction of splenic flexure – descending colon’.