Repercussões para o trabalho, a saúde e as relações familiares dos policiais feridos por arma de fogo em face / Repercussions on work, health and family relationships of police officers wounded by gunshot to the face

Resumo O objetivo deste artigo é identificar o perfil dos pacientes operados em decorrência de ferimentos na face por arma de fogo (FAF), a distribuição anatômica destes ferimentos e conhecer as repercussões sobre a saúde, o trabalho e as relações familiares dos policiais atingidos. Foi realizado um estudo epidemiológico retrospectivo a partir de dados secundários referentes aos policiais militares que foram operados no Hospital Central da Polícia Militar do Rio de Janeiro em decorrência de FAF em face, no período de junho de 2003 a dezembro de 2020 (N=87). Agregam-se dados de abordagem qualitativa oriundas de respostas abertas e fechadas fruto de aplicação de questionário (N=37) posteriormente aos ferimentos, indagando sobre as repercussões do acidente violento vivido para o exercício do trabalho, na família e para a saúde do policial. O perfil dos policiais operados evidencia: sexo masculino, idade média de 34,9 anos, praças e feridos em serviço. As fraturas mandibulares foram as mais encontradas. Houve piora nas condições de saúde física após os ferimentos com aumento de casos de hipertensão, insônia (59,4%) e cefaleia (51,3%). Os danos nas relações familiares demonstraram uma maior tendência de autoisolamento do policial e sentimento de medo vivenciada por seus parentes.

Abstract This article aims to identify the profile of police officers who underwent surgery due to gunshot wounds to the face, to survey the anatomical distribution of injuries and the repercussions on their health, work and family relationships. We conducted a retrospective epidemiological study based on secondary data of police officers who underwent surgery at the Central Military Police Hospital of the state of Rio de Janeiro due to gunshot wounds to the face from June 2003 to December 2020 (N=87). We also adopted a qualitative approach by applying a questionnaire with open and closed questions (N=37) to survey repercussions of the violent event on police officers' work, families and health. The profile of police officers who underwent surgery showed that they were exclusively males, aged 34.9 years on average, privates, and injured in the line of duty. Fractures of the mandibular region were the most frequent injuries. After the accident, physical health conditions of police officers deteriorated, including an increase in cases of hypertension, a high frequency of insomnia (59.4%), and headache (51.3%). Damaged family relationship included an increasing trend of self-isolation and a feeling of fear experienced by police officers' family members.

Tratamiento definitivo en traumatismo avulsivo de la región cérvico-facial: presentación de caso clínico / Definitive treatment in avulsive trauma of the cervico-facial region: clinical case report

Resumen Introducción: Las lesiones autoinfligidas por armas de fuego con cañón largo en la zona cérvico-facial no siempre logran consumar el suicidio y pueden ocasionar una herida avulsiva de esta región anatómica. Objetivo: Socializar los beneficios del tratamiento multidisciplinario inmediato en la atención al paciente con traumatismo facial complejo. Caso clínico: Paciente masculino de 60 años de edad con intento autolítico por arma de fuego, con pérdida importante de tejido a nivel mandibular y compromiso de la vía aérea. Resultados: Las distintas etapas de accionar quirúrgico se lograron en las primeras cuatro horas desde que sucedió el incidente. El paciente no presentó complicaciones posoperatorias ni necesidad de una nueva operación. Discusión: En la actualidad existe la tendencia a realizar tratamiento definitivo en un solo tiempo quirúrgico inicial. Conclusión: La intervención inmediata y protocolizada de las especialidades cirugía general, maxilofacial y cirugía plástica-reconstructiva en pacientes con heridas avulsivas de la región cérvico facial pueden lograr un tratamiento definitivo en un único tiempo quirúrgico y con resultados favorables.

Introduction: Self-inflicted injuries by long-barreled firearms in the cervico-facial area do not always succeed in consummating suicide and may result in an avulsive injury of this anatomical region. Aim: Socializing the benefits of the immediate multidisciplinary treatment in the medical care of patients with complex facial trauma. Clinical case: A 60-year-old male patient with an autolytic attempt by firearm, with loss of tissue at the mandibular level, as well as airway compromise. Results: The different stages of the surgical action were achieved during the first four hours since the incident occurred. The patient was discharged without the need for a new surgical procedure. Discussion: Currently there is e tendency to perform definitive treatment in a single initial surgical procedure. Conclusión: The immediate and protocolized intervention of specialties such as General Surgery, Maxillofacial and Plastic-Reconstructive Surgery in patients with avulsive wounds of the cervical-facial region can achieve a definitive treatment in a single surgical time and with favorable results.

Ferimentos não fatais por arma de fogo entre policiais militares do Rio de Janeiro: a saúde como campo de emergência contra a naturalização da violência / Non-fatal gunshot wounds among military police in Rio de Janeiro: health as a field of emergency against the naturalization of violence

Resumo Esse artigo aborda a ocorrência de agravos à saúde decorrentes de ferimentos por arma de fogo (FAF) que atingiram policiais militares da ativa na Região Metropolitana do Rio de Janeiro (RJ). Pesquisa documental, por meio de análise de prontuários médicos de policiais militares atendidos no Hospital Central da Polícia Militar (HCPM) em decorrência de FAF, no período de junho de 2015 a dezembro de 2017 segundo variáveis relativas ao perfil profissional, às características do evento e da lesão, à distribuição espacial dos FAF e às unidades de saúde envolvidas no atendimento. No período investigado, 475 policiais militares sofreram ferimentos por armas de fogo: 98,3% do sexo masculino, 77,3% encontravam-se em serviço, 97,9% eram praças. Quanto à localização anatômica dos ferimentos, as regiões mais acometidas foram: membros inferiores (41,1%) e superiores (33,1%), região da cabeça-pescoço-face (23,5%) e tórax-abdome (17,3%). As áreas na Região Metropolitana do Rio de Janeiro onde foram encontradas as maiores ocorrências de morbidade por arma de fogo foram as áreas de planejamento 3 e 1 e a Baixada Fluminense. Constatou-se correlação entre as taxas de morbidade policial por armas de fogo dos municípios da região metropolitana e densidade demográfica (p = 0,024).

Abstract This article discusses health problems due to firearm injuries suffered on duty military police officers in the metropolitan region of Rio de Janeiro (RJ). Medical records analysis was con ducted referring to military police officers who were treated at the Military Police's Central Hos pital (MPCH) due to gunshot wounds from June 2015 to December 2017 according to professional profile, the characteristics of the event and the le sion, the spatial distribution of the incidents in volving gunshot wounds, and the healthcare units involved in their care. Firearms injured four hun dred seventy-five military police officers: 98.3% were male, 77.3% were in service, 97.9% were soldier personnel. As to the anatomical location of the wounds, the most affected regions were: lower (41.1%) and superior (33.1%) limbs, the head neck-face region (23.5%), and thorax-abdomen (3%). The areas in the metropolitan area of Rio de Janeiro with the highest occurrence of firearm morbidity are program areas 3 and 1 and the Baixada Fluminense. There is a correlation between police morbidity rates due to firearm injuries in the municipalities of the metropolitan region and demographic density (p = 0.024).

Migración de proyectil de arma de fuego en vía urinaria: Reporte de un caso con enfoque Médico Legal / Migration of a bullet from a gunshot wound in the urinary tract: A case report with Legal Medicine approach

Resumen La migración de un proyectil de arma de fuego por la vía urinaria y expulsión espontánea del mismo por el meato urinario es un hecho infrecuente. Se presenta el caso de un masculino de 24 años de edad, quien sufrió herida por proyectil de arma de fuego con orificio de entrada en el muslo derecho, sin orifico de salida, se observó mediante una radiografía el proyectil alojado en la pelvis, dos meses y medio después el paciente se presenta al servicio de emergencias con el proyectil ubicado en la uretra, el cual se extrajo por el meato urinario sin complicaciones. Se hizo una revisión de la literatura sobre migración de proyectiles de armas de fuego.

Abstract Migration of a bullet through the urinary tract and spontaneous expulsion through the urinary meatus is an uncommon event. We present a case of a 24-year-old male, who suffered a gunshot wound with an entry hole in the right thigh, without an exit hole, and the projectile lodged in the pelvis was observed by radiography, two months and a half later the patient presented to the emergency service with the projectile located in the urethra, which was removed through the urinary meatus without complications. A review of the literature on migration of bullet projectiles was made.

Impacto de la infección por SARS-CoV-2 (COVID-19) en el tratamiento de una lesión duodenal por arma de fuego / Impact of SARS-CoV-2 infection (COVID-19) in the treatment of duodenal gunshot injury

RESUMEN Se presenta el caso clínico de un paciente con traumatismo abdominal por herida de arma de fuego (HAF). En otra institución se realizó cirugía de exclusión pilórica y hepatorrafia por lesión hepatoduo denal. Fue derivado a nuestra institución a las 12 horas posoperatorias. Intercurre en el posoperatorio con neumonía grave por COVID-19 y complicaciones de su cirugía ini cial. La presentación severa de la enfermedad nos inclina por el manejo no operatorio. La utilización de drenajes percutáneos permitió el manejo de colecciones evitando una cirugía mayor inicial. La recuperación pulmonar facilitó la cirugía definitiva. La neumonía severa por COVID-19 en un paciente con lesión duodenal grave por HAF condiciona la toma de decisiones.

ABSTRACT We report the case of a patient with an abdominal gunshot trauma with liver and duodenal injury who underwent pyloric exclusion and liver repair in another institution. The patient was transferred to our institution 12 hours after surgery. During hospitalization, severe pneumonia due to COVID-19 and complications of the initial surgery developed. Non-surgical management was decided due to the severity of the disease. Percutaneous drainage allowed for the management of the collections avoiding a major initial surgery. Once he recovered from the pneumonia, the definite surgery was performed. Severe COVID-19 pneumonia in a patient with serious duodenal shotgun injury is a determining factor for decision-making of treatment options.

Current status regarding selective non-operative management of abdominal gunshot wounds / 解放军医学杂志

Laparotomy should be routinely performed in the cases of abdominal gunshot wounds. However, recent studies found that 20%-30% abdominal gunshot wounds were non therapeutic or negective, and some complications secondary to laparotomy, such as local infection, often developed. Selective non-operative management (SNOM) can reduce the incidence of operative complications, length of hospitalization, and medical cost, thus has been recommended for the patients with abdominal blunt and stabbing wounds. However, it remains obscure whether SNOM is suitable for patients with abdominal gunshot wounds and which patients should be suitable for SNOM. This paper aims to review the important findings from questionnaire survey, clinical practice studies, and large-scale systematic reviews, and then propose how to identify the candidates for SNOM, hoping to be helpful for improving our management strategy of abdominal gunshot wounds.

Adrenal gland injury due to gunshot / 中华创伤杂志(英文版)

Adrenal gland trauma is a rare phenomenon, due to the small size and retroperitoneal location of the organ. The majority of adrenal gland trauma is due to blunt force injury and is only rarely encountered due to the penetrating mechanisms. A 20-year-old male sustained a gunshot wound to the left abdomen. Upon exploration, he was found to have a through and through injury to the left adrenal gland, among other injuries. Injury to the adrenal gland due to penetrating trauma is exceptionally rare. The principles of management are to control bleeding from the gland with debridement and hemostasis rather than attempt to resect the entire organ. The management of a penetrating injury to the adrenal gland is straightforward and should not be a contributor to a patient's morbidity or mortality.

Manejo endovascular de fístula arteriovenosa postraumática / Endovascular management of post-traumatic arteriovenous fistula

Resumen Objetivos Reportar un caso de fístula arteriovenosa crónica como una complicación tardía por una herida de arma de fuego, la cual se manejó con colocación de una endoprótesis recubierta en arteria femoral. Diseño Se tomaron imágenes y el registro del Hospital Central Militar para reportar el caso clínico. En el siguiente artículo describimos la experiencia del Hospital Central Militar en el tratamiento de la fístula arteriovenosa crónica con el manejo endovascular.

Abstract Objectives To report a case of chronic arteriovenous fistula as a late complication of a gunshot wound, which was managed with a covered stent placement in the femoral artery. Design Images and records were taken from the Central Military Hospital to report the clinical case. In the following article, we describe the experience of the Central Military Hospital in the treatment of a chronic arteriovenous fistula with en endovascular management.

Incidence Of Firearm-Related Deaths And Epidemiology In Klang Valley, Malaysia From 2006 To 2016: A Retrospective Study

@#Death due to firearm is more common in countries with higher gun ownership such as United States of America compared to countries with restrictive gun ownership such as European countries and Malaysia. However, the increasing number of shooting cases in Malaysia recently should not be overlooked. This study was carried out to investigate the incidence of firearm-related deaths and epidemiology in Klang Valley for 11-year period. The demographic data on the incidence of firearm-related deaths from 2006 to 2016 was collected retrospectively from four government hospitals in Klang Valley. 204 cases of firearm-related deaths were reported with irregular trend of the incidence throughout the 11-year period. The results revealed that most victims were male, aged between 30 to 34 years old and Malaysian citizen. Firearms fatalities were higher among Malaysian specifically Indian, as compared to non-Malaysian. Most firearms fatalities were homicides and took place during late night between 12.00 am to 5.59 am. The highest cause of death was head injury due to gunshot wound. It is hoped that this study will raise awareness to Malaysian citizen regarding firearm-related cases and to develop strategies to overcome the issue of gun violence in Malaysia with appropriate authorities.

Herida facial por proyectil de arma de fuego: revisión de literatura y estudio clínico de tres casos / Gunshot caused facial wound. Literature review and clinical study of three cases

El tratamiento de las heridas por arma de fuego en la región maxilofacial es un tema complejo, controversial especialmente en relación al tiempo de tratamiento. La literatura actual respalda el tratamiento inmediato sobre el tardío, presentando mejores resultados. Las heridas son heterogéneas con particularidades que deben analizarse y definir su tratamiento con base en los principios de Kazanjian y Converse, pero adaptándose a las necesidades específicas. Su manejo va en relación al tipo de arma, características deformantes de la bala, energía cinética, lugar de impacto y estado sistémico del paciente. El objetivo del trabajo es realizar una revisión bibliográfica y exponer nuestra experiencia en el manejo de heridas por arma de fuego a nivel maxilofacial. Se presenta el tratamiento de tres casos de heridas faciales por arma de fuego atendidas en el Hospital Regional « General Ignacio Zaragoza ¼ .

Treatment of gunshot wounds in the maxillofacial region is a complex subject, especially controversial with respect to treatment time. Current literature supports immediate treatment rather than late care, claiming to achieve better results. Wounds are heterogeneous, with characteristics that must be analyzed so as to define treatment according to Kanzanjian and Converse' s principles, but always adapting to specific needs. Handling is dependent upon type of weapon, bullet's disfiguring characteristics, kinetic energy, place of impact as well as patient' s general health circumstances. The aim of the present research was to conduct a bibliographic review and expose our experience in maxillofacial gunshot wound treatment. We hereby document treatment of three facial gunshot wound patients who sought treatment at the Regional Hospital «General Ignacio Zaragoza¼, Mexico City, Mexico.

Fracture of the Humeral Shaft Secondary to High-Velocity Gunshot (Machine Gun) Injury: A Case Report

High-velocity gunshot injury (muzzle velocity greater than 609.6 m/s) is uncommon and primarily a military injury. Humerus shaft fracture, caused by a high-velocity gunshot, should be considered as a severe open fracture. The principles of treatment are immediate and aggressive irrigation, wide debridement, primary delayed wound closure, and broad-spectrum intravenous antibiotics. External fixation has been widely used for fracture fixation. We report a case of humerus shaft fracture secondary to high-velocity gunshot (machine gun) injury, with a literature review.

Incomplete Isolated C7 Root Injury Caused by Gunshot Wound: A Case Report / 대한신경손상학회지

Gunshot wounds to the spine cause severe neurological and/or internal organs damages. Although most of publications in the literature are realized on military injuries, increased civilian arming which raises civilian gunshot injuries is a new social danger causing serious health problems. In gunshot injuries to the spine; vertebral column, spinal cord and nerve roots are damaged with direct, indirect and transient cavitation related mechanisms. In this case report, we present 24 years old male patient who had severe pain and monoparesis in left upper extremity followed by gunshot injury to the spine with clinical, radiological and postoperative follow-up findings.

Sinusitis maxilar como secuela de herida por arma de fuego / Maxillary Sinusitis as a Sequel to Gunshot Wound

Las heridas por arma de fuego no están dentro de las causas más frecuentes de traumas nasales, y a su vez las sinusitis relacionadas con esta causa son más infrecuentes aún. Se presenta un caso que, a punto de partida de una herida por arma de fuego, se produce amputación de cornetes inferior, medio y una sinequia de la fosa nasal izquierda, que producen mala ventilación del seno homolateral e infección de la cavidad, desarrollando un cuadro sinusal, que respondió al tratamiento habitual sin otras consecuencias. Dada la magnitud del agente causal y teniendo solo una sinusitis como secuela, se presenta este caso donde por la infrecuente experiencia como causa de sinusitis(AU)

Gunshot wounds are not among the most common causes of nasal trauma, and sinusitis related to this cause is even rarer. A case is presented of amputation of inferior, middle turbinates and a sinensis of the left nostril from a gunshot wound. It produced poor ventilation of the sinonasal sinus and infection of the cavity, developing a sinus condition, which responded to the usual treatment without other consequences. This case is presented given the magnitude of the causal agent, having only one sinusitis as a sequel as cause of sinusitis(AU)

Combat-Related Intradural Gunshot Wound to the Thoracic Spine: Significant Improvement and Neurologic Recovery Following Bullet Removal

The vast majority of combat-related penetrating spinal injuries from gunshot wounds result in severe or complete neurological deficit. Treatment is based on neurological status, the presence of cerebrospinal fluid (CSF) fistulas, and local effects of any retained fragment(s). We present a case of a 46-year-old male who sustained a spinal gunshot injury from a 7.62-mm AK-47 round that became lodged within the subarachnoid space at T9-T10. He immediately suffered complete motor and sensory loss. By 24-48 hours post-injury, he had recovered lower extremity motor function fully but continued to have severe sensory loss (posterior cord syndrome). On post-injury day 2, he was evacuated from the combat theater and underwent a T9 laminectomy, extraction of the bullet, and dural laceration repair. At surgery, the traumatic durotomy was widened and the bullet, which was laying on the dorsal surface of the spinal cord, was removed. The dura was closed in a water-tight fashion and fibrin glue was applied. Postoperatively, the patient made a significant but incomplete neurological recovery. His stocking-pattern numbness and sub-umbilical searing dysthesia improved. The spinal canal was clear of the foreign body and he had no persistent CSF leak. Postoperative magnetic resonance imaging of the spine revealed contusion of the spinal cord at the T9 level. Early removal of an intra-canicular bullet in the setting of an incomplete spinal cord injury can lead to significant neurological recovery following even high-velocity and/or high-caliber gunshot wounds. However, this case does not speak to, and prior experience does not demonstrate, significant neurological benefit in the setting of a complete injury.

Caracterización de las lesiones vasculares por tomografía computada (TC) en heridas de arma de fuego: experiencia de tres años en hospital público del sector suroriente de Santiago de Chile / Characterization of vascular lesions in firearm wounds, using computed tomography (CT): three years experience in a public hospital in the southeastern area of Santiago, Chile

Resumen: Objetivos. Conocer las características epidemiológicas y radiológicas en TC, de las lesiones vasculares en pacientes que han sufrido heridas por arma de fuego (HAF), en el servicio de urgencia de un hospital público de Santiago-Chile, en un período de tres anos. Material y método. Revisión retrospectiva de 211 TC realizadas a pacientes ingresados al servicio de urgencia con diagnóstico de HAF entre 31/05/2009 y el 31/05/2012. Se incluyeron pacientes con TC dentro de las primeras 48 horas de ocurrido el evento, excluyendo los pacientes que por su condición clínica, fueron a intervención quirúrgica previa a la TC, obteniendo un N° final de 178. Se analizó la distribución según sexo, edad, tipo de lesión vascular, segmento topográfico afectado, tipo de proyectil y outcome de los pacientes. Resultados. El 96,8 por ciento (n°= 31) de los afectados fueron hombres, 71,8 por ciento menores de 36 años. El segmento más afectado correspondió a las EEII, con un 55,8 por ciento. El tipo de lesión que más frecuente fue el pseudoaneurisma y la hemorragia activa, con un 20,5 por ciento en cada caso. El tipo de proyectil que más frecuentemente se encontró, fueron las balas (65 por ciento) y en la gran mayoría de las veces, sin salida del proyectil. En nuestro grupo hubo un fallecido. Conclusión. Si bien el trauma vascular representa un bajo porcentaje dentro del total de las lesiones por trauma, su extrema gravedad, y por ende necesidad de diagnóstico certero y precoz, explica la importancia del conocimiento y familiarización que los radiólogos deberíamos tener con ese tipo de lesiones. Las extremidades son el principal sitio de lesiones vasculares por herida penetrante, alcanzando hasta el 70 por ciento en nuestro trabajo. En estos casos los exámenes imaginológicos muchas veces son sólo complementarios, porque clínicamente el diagnóstico está hecho, no así en las lesiones de vasos intratorácicos e intra-abdominales, donde las imágenes son indispensables para su...

Objectives. To determine the epidemiological and CT characteristics of vascular lesions in patients who have suffered gunshot wounds, in the emergency department of a public hospital in Santiago, Chile, over a period of three years. Material and Methods. Retrospective review of 211 CT performed on patients admitted to the emergency department with gunshot wounds, between 31/05/2009 and 31/05/2012. Patients with a CT within the first 48 hours after the event occurred were included, excluding patients who for their clinical condition, underwent surgery prior to the CT, obtaining a final number of 178. Distribution was analyzed by sex, age, type of vascular injury, topographic segment affected, projectile type and outcome of patients. Results. 96.8 percent (n° = 31) of those affected were men, 71.8 percent under 36 years. The most affected segment were to the lower extremities, with 55.8 percent. The most frequent type of injury was pseudoaneurysm and active hemorrhage, with 20.5 percent in each case. The type of projectile most frequently found were bullets (65 percent) and the majority, without projectile exit. In our group there was 1 death. Conclusion. Although vascular trauma represents a low percentage of total trauma injuries, their seriousness, and therefore the need for early and accurate diagnosis, explains the importance of the knowledge and familiarity that radiologists should have, with that kind of injury. Extremities are the main site of vascular injury caused by penetrating wounds, affecting up to 70 percent in our sample. In these cases CT examinations are often only complementary because the diagnosis is made clinically; this is not the case in intrathoracic and intraabdominal vessel injuries, where images are essential for diagnosis.

Operative Management of a Sacral Gunshot Injury via Minimally Invasive Techniques and Instrumentation

Gunshot wounds to the spine account for 13% to 17% of all gunshot injuries and occur predominantly in the thoracic region. Minimally invasive spine surgery procedures implementing serial muscle dilation and the use of a tubular retracting system with a working channel minimize soft tissue trauma, facilitate less bony and soft tissue resection, decrease blood loss, minimize scarring and improve cosmesis, decrease hospitalization, and reduce postoperative pain and narcotic usage in comparison to more open, traditional approaches. Although minimally invasive spine surgery techniques and instrumentation have gained considerable attention, their application in the management of gunshot injuries to the sacrum has not been reported. The following is a brief case report of a 21-year-old male who sustained a gunshot injury to the sacrum who was managed operatively via minimally invasive spine surgery techniques and instrumentation.

Concept of Gunshot Wound Spine

Gunshot wound (GSW) to the spine which was earlier common in the military population is now being increasingly noted in civilians due to easy availability of firearms of low velocity either licensed or illegal combined with an increased rate of violence in the society. Contributing to 13% to 17% of all spinal injuries, the management of complex injury to the spine produced by a GSW remains controversial. Surgery for spinal cord injuries resulting from low velocity GSWs is reserved for patients with progressive neurologic deterioration, persistent cerebrospinal fluid fistulae, and sometimes for incomplete spinal cord injuries. Surgery may also be indicated to relieve active neural compression from a bullet, bone, intervertebral disk, or a hematoma within the spinal canal. Spinal instability rarely results from a civilian GSW. Cauda equina injuries from low velocity GSWs have a better overall outcome after surgery. In general, the decision to perform surgery should be made on consideration of multiple patient factors that can vary over a period of time. Although there have been plenty of individual case reports regarding GSW to the spine, a thorough review of unique mechanical and biological factors that affect the final outcome has been lacking. We review the key concepts of pathogenesis and management of GSW to the spine and propose an algorithm to guide decision making in such cases.

A Case Report of Spinal Cord Injury Patient From a High Velocity Gunshot Wound to the Lumbar Spine

We report on operational and rehabilitation management, as well as the outcome, of a patient who with sustained spinal cord injury from a high velocity gunshot wound to the lumbar spine. More specifically, a patient with a gunshot wound to the spine is more likely to sustain a complete injury and have a poor prognosis. As such, there should be concerns regarding associated and extended injuries related to bullet fragmentation as well as the possibility of long-term sequelae.

Management of a Gunshot Wound at the Temporal Region: Case Report

Fístula bíleo-brônquica / Bronchobiliary fistula

A fístula bíleo-brônquica é uma condição rara que pode ocorrer em decorrência de cistos hidáticos, intervenções cirúrgicas extensas e procedimentos invasivos para doença hepáticas. O objetivo deste trabalho é relatar o caso de um paciente com diagnóstico de fístula bíleo-brônquica após ferimento por arma de fogo que transfixou o tórax. Ressalta-se a importância de novos relatos a fim de dinamizar o diagnóstico e tratamento desses pacientes e assim diminuírem as morbidades relacionadas.

Broncho-biliary fistula is a rare condition that can occur due to hydatid cysts, extensive surgical interventions, and invasive procedures for liver disease. The aim of this study is to report the case of a patient with a diagnosis of broncho-biliary fistula after a gunshot wound that transfixed the chest. We stress the importance of new reports to streamline the diagnosis and treatment of these patients and thus decrease related morbidities.