Perforation of the colon in response to the blast effect of an extraperitoneal gunshot injury

INTRODUCTION AND IMPORTANCE: Gunshot injury has many medical aspects, and the blast effect is a rare one that needs a precise first emergency examination. CASE PRESENTATION: A 16-year-old male who was injured by a gunshot. Upon arrival at the emergency department, he was treated as a trauma call. There was only one bullet that entered from the outer edge of the right ASIS and exited inside the right buttock approximately 10 cm lower tangentially and no bullet entered the abdomen. Initial assessments and imaging revealed no underlying pathology findings, and the patient's vital signs were stable. Epigastric and RUQ tenderness and CT findings prompted us to perform a laparotomy. During laparotomy, we discovered a perforation in the hepatic flexure of the colon. CLINICAL DISCUSSION: It is believed that as the peritoneal cavity is not touched by bullet, the colon is perforated because of the blast effect of the gunshot. Although blast effects from gunshots or shotguns are rare, especially in intact abdomens, clinical staff should keep this effect in mind. This will ensure that they don't misinterpret the bullet path and external torso and don't miss anything subtle during their initial clinical examination. CONCLUSIONS: This case highlights the possibility of blast effect in gunshot cases and injury to organs that aren't in the bullet's path. Laparotomy is recommended if CT scan shows thickened colon wall in patients with extraperitoneal gunshot injury.