Air gun injuries to the abdominal aorta: report of two cases and review of the literature

Two case reports of fatal injuries sustained from tear gas guns loaded with pebbles as missiles

These two case reports are of fatal injuries from less-lethal weapons (tear gas guns) using pebbles as an unconventional ammunition. Reported here are the fatal outcomes of two 19-year-old males, one with head trauma and the other with abdominal trauma. They were admitted to the ED and subjected to immediate exploratory operations, but they passed away. On autopsy, the first case demonstrated a right frontal bone fracture with subdural hemorrhage and a 3 × 2.5 cm pebble retained in the skull. The second case showed severe liver laceration in close vicinity to a cubical pebble (3.2 × 3 cm). The mechanical forces involved in skull fracture and autopsy are discussed. In the current cases, the relatively larger weight and size together with the surface configuration of the pebble projectile were the main influential factors that contributed to the severity of damage and fatality.These case reports are a working example of the effect of the mass of projectiles in increasing the power of penetration. The direct shooting to the head and the abdomen together with the misuse of these weapons are capable of inflicting fatal injuries.

Forensic assessment of a life-threatening penetrating abdominal air gun injury

Air guns are considered mostly harmless by the public opinion, but projectiles shot from common air guns can penetrate skin and thus able to cause severe, even life-threatening injury. The prevalence of air gun injuries is constantly high, but severe injuries occur rarely. Forensic evaluation of air gun injuries can be challenging since the shot wound characteristics produced by combustion in case of firearm injuries are missing. Despite these difficulties, the topic of air gun injuries is mostly overlooked in forensic literature, and there are no guidelines available which can help the assessment of specific cases. A case of an air gun injury is reported, where the projectile penetrated the abdominal wall and created multiple bowel injury. The complex assessment of all available information (macroscopic and microscopic appearance of entrance wound, types of injuries, CT findings, and crime scene reconstruction) helped to uncover the truth about the circumstances of the injury.

Homicide Using an Air Weapon

The debate over the lethality and ownership of modern, high-powered weapons has recently grabbed the headlines. High-velocity air weapons, advertised as starter guns for children, can cause lethal injuries despite non-lethal appearing wounds. Presented is a rare case of a modern, high-powered air weapon used in a homicide. A literature search yielded reports of only three previous murders by air weapon in the United States and only one involving injury to the thorax. In the current case, the killer used a diabolo pellet to penetrate the chest. The pathway tracked through the sternum, piercing the anterior pericardial sac and perforating the right ventricle, which led to a pericardial effusion. The pellet embolized to the left pulmonary artery and eventually the vasculature of the left lung. Cause of death was a penetrating gunshot wound of the chest most likely leading to cardiac tamponade. This case exemplifies several important characteristics of penetrating chest trauma from air guns: first, air rifles, with exit velocities up to 1200 feet per second, can kill and have been used in accidental deaths, homicides and suicides; secondly, diabolo pellets may embolize just as bullets can; and lastly, minor external damage may mask major internal destruction.

Endovascular repair of innominate artery injury secondary to air rifle pellet: a case report and review of the literature

OBJECTIVE

Decreased morbidity makes endovascular treatment preferable for certain central aortic and great vessel injuries. We present a case of penetrating innominate injury, describe considerations of a catheter-based approach, and provide follow-up of repair.

METHODS

A case report and review of the literature.

RESULTS

A 16-year-old man presented with an isolated innominate artery injury following an air rifle wound. Standard transfemoral approach was used to gain access the innominate artery. The injury was treated with an 8 x 35 mm, balloon-expandable, covered stent. Completion imaging confirmed a well-positioned stent with exclusion of the injury and normal flow in distal vessels. There were no symptoms of stent migration or stenosis 1 year following the injury.

CONCLUSIONS

Specific anatomic characteristics including its proximity to the carotid and vertebral arteries make the endovascular approach to the innominate artery unique. This case demonstrates the viability of catheter-based approaches in treating vascular injury.