Loss of a Life that could be Saved: A Case Report of Gunshot Trauma and Review of Literature

Abstract

Thoracoabdominal gunshot wounds (GSWs) present a formidable clinical challenge due to the potential involvement of both thoracic and abdominal organs.We present the case of a 45-year-old male who sustained a self-inflicted gunshot wound to the left chest. Despite hemodynamic stability on admission, critical elements of trauma evaluation—including general surgery consultation and full secondary survey—were omitted. Initial CT imaging revealed pulmonary injury, hemothorax, minimal pneumothorax, and elevated left hemidiaphragm, but failed to identify intra abdominal pathology. The following day, the patient collapsed due to metabolic acidosis and septic shock. Exploratory thoracotomy and laparotomy revealed massive hemoperitoneum, a grade 4 splenic injury, and dual gastric perforations. Although surgical repair and resuscitative efforts were undertaken, the patient developed ventilator-associated pneumonia,refractory sepsis, and multiorgan failure, ultimately leading to death. This case illustrates the dangers of incomplete trauma assessment and overreliance on imaging in the evaluation of thoracoabdominal GSWs. Diaphragmatic injuries and associated visceral trauma can be subtle or initially occult, particularly on the left side. A high index of suspicion, adherence to trauma protocols, and early multidisciplinary collaboration are essential to avoid missed injuries and improve patient outcomes.