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by Nemislenina

noctuabunda in science_beta

Medical question: bullet wound

First of all, I just want to say I'm glad this comm is still around! Thanks for not deleting it.
And now, for my question referring - once again - to a bullet wound.



Okay, so I have this guy shot in the back. I haven't been specific about range or caliber, but the exit wound (stomach) is bigger than the entry wound (back). I also wasn't very specific about the wound, all I said was that
a) it's in the stomach area
b) it bleeds a lot
c) the bullet went straight through the body.
d) the shot guy was fading in and out of consciousness, but while conscious, still able to talk.

Now for the questions: As far as I know, the liver is one of the most... "robust" human organs, so does that mean that the patient would recuperate quickly? How quick? Also, there are a lot of important arteries (veins?) running through it, so it would bleed a lot, right?
All in all, some muscle and liver damage would be what I think that shot did to the poor victim. But would there be any other organs in the way? Would his intestines be damaged, too? And does that automatically lead to a sepsis?

I'd be extremely thankful for any help!

Comments

I'll do my best to answer all of your questions. ;)

As far as I know, the liver is one of the most... "robust" human organs, so does that mean that the patient would recuperate quickly? How quick?

Yes, the liver is very resilient. You can lose function to half of it an still lead a fairly normal life. What most people experience with liver injury is pain and weakness. Depending on how much liver is involved, recuperation can last anywhere from a week or so to several months.

Also, there are a lot of important arteries (veins?) running through it, so it would bleed a lot, right?

Absolutely! Actually, there are more "other things" running through the liver than there are arteries. The portal vein provides about 2/3 of the blood supply to the liver, the rest is from the hepatic arteries. The hepatic veins drain the liver to the inferior vena cava. Then you have the bile ducts. The liver makes bile (which helps digest fats) and drains it via bile ducts to the gallbladder and ultimately to the intestines. You really don't want to injure the portal vein or the bile ducts (the right and left hepatic ducts, the common hepatic duct, and the common bile duct specifically). Even if the bullet managed to miss all of those vessels (which is entirely possible) it would still hit branches and there would be quite a lot of bleeding. Enough to cause shock, which is the situation it seems you've created. He'd have a very high heart rate, a very low blood pressure, and may be breathing fast as a result.

All in all, some muscle and liver damage would be what I think that shot did to the poor victim. But would there be any other organs in the way?

It depends on the path of the bullet. If it went through and through, which I think would have to be high speed and relatively close range (but I could be wrong), then he could manage to have just liver injury. The entrance and exit sites would be left open, by the way, and packed with damp dressings until they heal. If the bullet did not go straight through, there could be any amount of organ injury.

Would his intestines be damaged, too?

Possibly, and maybe even probably. What I've seen with gun shot wounds, is that the bullet tends to wiggle around in its path. Colon and small intestine injury are the most common thing I've seen. The location of your bullet track, you could have liver injury, gallbladder injury, intestine injury (probably colon, maybe some small intestine) and maybe kidney injury. Obviously, the guy's in for surgery, with a great big incision from the bottom of the breast bone probably all the way down to the pubic bone.

And does that automatically lead to a sepsis?

Nope. But sepsis is a possibility, even without bowel injury. If he does have an injury to the colon, stool nearly always spills into the abdomen, making it unsafe to just cut out the injured area and sew the ends back together, so he'd probably have a temporary colostomy. A measure to attempt to avoid sepsis and the like.

Okay, I've been really long-winded. Sorry. ;) But I do hope you've been able to make some sense of it and that it helps! I'd be happy to answer any other questions you have, or ones I've created. ;)
Wow, thank you so much for your detailed answer! You've already been a big help.

However, the more I know the more I want to know, so I hope you won't mind my next few questions:

I've written that he has some damage to his liver and his intestines, but all in all he's been lucky (small damage, no sepsis). But he would still get the colostomy, right? Could you maybe just give me a kind of timetable? What I'd like to know is:

a) How long is he going to have the colostomy? (And how is it removed? It doesn't
smell, does it?)
b) How long is he going to stay in the hospital?
c) How long is he going to be unable to work?

Also, this might help you with your answer: The victim is Casey from Chuck - just your regular big tough guy, healthy and pretty strong. His work - at least the cover, he's a secret agent - is a sales clerk, so not too physically demanding. I guess it'll take him longer to get back to regular missions, though.

Thank you so much for your help! And if it takes up too much of your time to answer these questions, just tell me. I'll write around it then.
So it sounds like his liver will be just fine. =) If the damage is to the colon, and there is spillage from it being torn in two parts or having a large hole (which is most of the time in the colon) then yes, he'd get the colostomy. If the injury, however, is just a nick in the colon (say, less than 1 inch) it could actually be repaired and he wouldn't need a colostomy. If the injury is to the small intestine, then the injured area would be cut out and the ends sewn back together. With or without the colostomy, the course after surgery is basically the same, provided there are no complications that develop.

a) He'd keep the colostomy 3-4 months, to give everything time to heal and for internal swelling to go down. They usually don't smell so long as the bag is kept sealed. A colostomy is removed in another operation, which would require another 3-7 day hospital stay.

b} If everything goes well during surgery, he'd only have to stay however long it takes him to be able to take care of himself (as far as showering, walking, eating and such goes) and until his bowels are working again. After surgery, he wouldn't be allowed to eat until he passed gas (has air in the colostomy bag) - usually about 2-3 days - and then he'd be allowed to drink liquids. Some surgeons will let people eat regular food the next day if they've not gotten nauseated after the clears, but others wait on solid food until they have a bowel movement/colostomy output. That's usually 1-2 days later. So, if everything goes perfect, he could be out of the hospital in as little as 4 days. My experience is that nothing goes perfect, so I'd say a 5-6 day stay is more reasonable. He would be encouraged to walk as much as he could handle while in the hospital, that can speed up regaining bowel function. And he would probably have a NG tube (nasogastric tube, goes through the nose and into the stomach to drain it to give the gut a day to rest and to help with nausea from the decreased motility) for a day or two after surgery.

c) To get back to sales clerk type work, probably 2-3 weeks. For the secret agent work, probably more like 6-8 weeks. It all really depends on how he feels. Some people are bound and determined to go back to work earlier.

Again, I've been chatty. I honestly don't mind answering at all, that's why I joined. I hope that these answers have helped! =D
They absolutely did, thank you so much! :D