Bullets are not sterilized by the heat of firing. They can carry bacteria from the body surface or body organs, such as a perforated colon, deep into the wound.
In trunk wounds, an analysis of the bullet path is mandatory to determine whether a laparotomy is needed. Two radiographs in planes separated by 90°, computed tomography (CT), clinical examination, and peritoneal lavage are all useful. Abdominal CT is more accurate if performed before peritoneal lavage. If peritoneal penetration by a bullet is suspected, laparotomy is indicated. 22 The morbidity and mortality rates of an exploratory laparotomy that shows no significant intraabdominal injury are low compared with those of missed intestinal injury. CT is useful, especially when an exclusively body wall or retroperitoneal path is suspected. CT has largely replaced excretory urography as the preferred means of evaluating the urinary tract after penetrating trauma.
Any bullet wound below the nipple line should raise the question of whether the diaphragm or abdomen has been penetrated. CT sometimes can be used to make this determination. Laparotomy is required if peritoneal penetration cannot be excluded. 22
Whenever a gunshot wound traverses the midline of the neck or the width of the mediastinum, perforation of the esophagus should be suspected. Esophageal evaluation should not be overlooked after angiographic evaluation of the neck or chest.
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