A 60 y old male patient comes to emergency around 8 pm with a gun shot injury to abdomen, he was shot around 5pm same day.
Patient was drowsy, with tachycardia and shock.
Entry wound left subcostal area, exit wound left lower lumbar area.
We were expecting hemoperitoneum with small bowel and colonic perforation.
As patient was not vitally stable, patient was prepared for emergency laparotomy after explaining all the risks, possibilities and prognosis.
Abdomen was explored through a midline incision, around 1 ltr of blood and blood clots were present in the left side of the abdomen, bowel was explored for active bleeding and perforations.
There were multiple perforation in the jejunum, proximal most was at 6 inch from the DJ, part of mesentery was actively bleeding, the vessel ligated.