Perforation of the colon from the primary blast effect of an extraperitoneal shotgun injury: case report.

Blast trauma can result in injuries to peritoneal organs. Penetrating extraperitoneal shotgun wounds and even tangential gunshot or shotgun injuries of the abdominal or chest wall can result in damage to abdominal organs despite an intact peritoneum and diaphragm. Delays in diagnosis and operative repair of such bowel injuries are frequently associated with high morbidity and mortality rates. We present a case of a 47-year-old man with a history of depression and a self-inflicted shot-gun wound to the chest wall, which was tangential and never entered the chest cavity. Computed tomography of the chest revealed free subdiaphragmatic air. Exploratory laparotomy revealed a 4-cm perforation of the wall of the splenic flexure of the large bowel. There was no injury to the peritoneum, diaphragm, or other abdominal viscera. The colonic perforation was repaired by suturing with a stapling instrument. The operation was completed with an appendectomy and cecostomy.