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CASE REPORT
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Distant-range abdominal shotgun injury


 Department of Forensic Medicine and Toxicology, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India

Date of Submission29-May-2020
Date of Decision30-Jul-2021
Date of Acceptance30-Jul-2021

Correspondence Address:
Smitha Rani,
Department of Forensic Medicine and Toxicology, JSS Medical College, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagar, Bannimantap, Mysuru - 570 015, Karnataka
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_397_21

  Abstract 


In injuries caused due to firearms, the appearance of the wound has immense medicolegal implication since it can determine the type of projectile, its trajectory, and range of firing. Such observations can also assist in determining the manner of death. Herein, we report a case of homicidal gunshot injury caused by a smoothbore firearm. The characteristics of distant-range shotgun injury are presented. The need for appropriate forensic evaluation, documentation of injuries, and proper handling of evidentiary material in the clinical settings is highlighted.

Keywords: Distant range, firearm injury, role of emergency physician, shotgun



How to cite this URL:
Rani S, Arun M. Distant-range abdominal shotgun injury. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2022 Dec 7]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=335330




  Introduction Top


The incidence of firearm-related deaths is showing an increasing trend worldwide. In 2016, India reported 26,500 deaths due to firearm injury, placing itself in the third position in the most firearm-related deaths in the world.[1] As per the National Crime Records Bureau data, 73,122 cases were registered during 2019 under the Arms Act. Among the 79,547 arms seized, only 1980 arms were licensed/factory-made and the rest were either unlicensed or country-made.[2] As per the American College of Physicians, firearm violence is not only a criminal justice issue but also a public health threat.[3] Basic knowledge about firearm wound characteristics among the healthcare providers and appropriate documentation and handling of evidence by them will prove useful in future legal proceedings. Herein, we report a case of distant-range smoothbore firearm injury, the characteristics of smoothbore firearm injuries are discussed, and the role of an emergency physician is emphasized.


  Case Report Top


As per the history furnished by the investigating officer, the deceased, 38-year-old male was shot by his rival using a smoothbore firearm. He was shifted to the hospital wherein he was declared dead on arrival.

Autopsy findings

The body was subjected to a whole-body X-ray before the autopsy which showed multiple pellets in the right hand and the right abdominal region [Figure 1]. At autopsy, multiple punctured lacerations (entry wounds of pellets), circular to oval in shape, with inverted, irregular and blackened edges were present over an area of 27.5 cm × 22.5 cm on the front of the right half of the trunk and over the dorsum of the right hand involving an area of 13 cm × 6 cm [Figure 2]. No evidence of singeing, scorching, and tattooing was seen. On reflecting the abdominal wall, contusion of subcutaneous tissue was seen over the right side of the abdomen. Multiple punctured lacerations were seen on the inner surface of the right side of the abdominal wall. Contusion of the peritoneum and posterior mesenteric wall was noted. The peritoneal cavity contained 650 ml of blood. Multiple lacerations were found over the surface of the liver; pellets were recovered from the substance of the liver on further dissection [Figure 3]. All other abdominal visceral organs were intact and unremarkable. The toxicological analysis report was negative for the poisons analyzed. On perusal of the above findings, the cause of death was opined as death is due to hemorrhagic shock as a result of gunshot injury sustained over the trunk caused by a smoothbore firearm.
Figure 1: X-ray examination conducted before autopsy showing multiple pellets in the right hand and the right abdominal region

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Figure 2: Multiple entry wounds caused by pellets over the front of the right half of the trunk and the dorsum of the right hand

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Figure 3: Multiple lacerations present over the surface of the liver and pellets recovered from the substance of the liver

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  Discussion Top


Shotguns have a smoothbore. They are usually employed to fire multiple pellets although they can fire a single projectile. Wounds caused are classified into contact, close-range, intermediate-range, and distant-range wounds based on the range of firing. The range of firing for a given shotgun can be precisely measured by test firing that shotgun with the same brand of ammunition and then comparing the findings with the description of the shotgun wound.[4] The features expected to be seen in close-range wounds are the presence of a wad in the wound, as well as the patterns of the scorching, blackening, and powder tattooing around the wound. In the intermediate range, wound edges would be scalloped or crenated surrounded by powder tattooing. Distant-range wounds can have a central defect surrounded by satellite pellet wounds. As the distance of the firing increases, the pellets disperse; hence, there would be the absence of central defect and only satellite lesions are seen.[5] In our case, there was no central defect and only the satellite wounds were seen; such a pattern of injury is usually seen when the range of firing is approximately more than 4 m. By measuring the area of spread, we can approximately determine the range of firing. The diameter of the spread of pellets in inches is roughly equal to the range in yards multiplied by 1.5.[6]

Comprehensive forensic evaluation in the clinical settings should comprise appropriate recording of the patient's and clinician's names, date and time of admission, full history and examination, and date and time of death. The wound description should include the anatomical location, size, shape, and associated characteristics such as marks or coloration. If surgical interventions are done, the same has to be documented since they can alter the appearance of the wound. Documentation of the injuries through photographs and X-ray to show the presence of projectile should be done whenever possible. One should refrain from commenting on the wound to be entry/exit in the clinical documents. The remarks on direction and range of firing should not be made. Collection of evidence will include collecting the projectiles and clothes worn by the patient. Recording and proper preservation of any evidence obtained, as well as effective chain of custody maintenance, is also vital.[7] Since the emergency physicians are the first responders, the precision of the initial clinical documentation has a pivotal role to play in the court proceedings since this can assist the forensic pathologists, police, and legal authorities in the appropriate evaluation of the case.


  Conclusion Top


The primary role of the physicians is to provide immediate and optimal care to the patient. However, basic knowledge about wound ballistics, relevant forensic terminologies, and familiarizing oneself with the forensic approach in such cases would help in administering justice to the victim of such offences. This would help in strengthening our legal system thus contributing to the betterment of our society.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Global Burden of Disease 2016 Injury Collaborators, Naghavi M, Marczak LB, Kutz M, Shackelford KA, Arora M, et al. Global Mortality From Firearms, 1990-2016. JAMA 2018;320:792-814.  Back to cited text no. 1
    
2.
National Crime Records Bureau, Ministry of Home Affairs, Government of India. Crime in India 2019. Available from: https://ncrb.gov.in/sites/default/files/CII%202019%20Volume% 201.pdf. [Last accessed on 2021 May 28].  Back to cited text no. 2
    
3.
Butkus R, Doherty R, Daniel H; Health and Public Policy Committee of the American College of Physicians. Reducing firearm-related injuries and deaths in the United States: Executive summary of a policy position paper from the American College of Physicians. Ann Intern Med 2014;160:858-60.  Back to cited text no. 3
    
4.
Di Maio VJ. Practical Aspects of Firearms, Ballistics and Forensic Techniques. 2nd ed. New York: CRC Press; 1999.  Back to cited text no. 4
    
5.
Gordon I, Shapiro HA, Berson SD. Forensic Medicine. 3rd ed. Edinburgh: Churchill Livingstone; 1997.  Back to cited text no. 5
    
6.
Pillay VV. Textbook of Forensic Medicine and Toxicology. 19th ed. Hyderabad: Paras Medical Publishers; 2019.  Back to cited text no. 6
    
7.
Vellema J, Scholtz HJ. Forensic Aspects of Ballistic Injury. In: Mahoney PF, Ryan JM, Brooks AJ, William Schwab C, editors. Ballistic Trauma. London: Springer; 2005.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

 
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   Abstract
  Introduction
  Case Report
  Discussion
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