Abstract text (incl. references and figure legends)
Case history: A 61-year-old woman was brought to the emergency room 30 minutes after being shot in the right hemithorax. Upon arrival of the paramedics, the patient was unresponsive, without measurable blood pressure. Clinical findings: Physical examination revealed gunshot injury with the entry wound 1 cm medially from the right nipple at the superior border of the areola. Patient had signs of peritoneal irritation. Additional injuries to the right palm were noted. Investigation/Results: Imaging revealed hematoperitoneum. The projectile penetrated right breast, continued its path through the breast implant, hit the fifth rib and then advanced through the liver and stopped paravertebrally at the level of the L2. Diagnosis: As the patient was hemodynamically unstable with confirmed liver injury and hematoperitoneum emergency laparotomy was performed. Therapy and progression: Surgery revealed active bleeding from the fourth and fifth liver segments, hemostasis was successfully achieved. Small diaphragmatic injury was closed up, damaged breast implant from the right side was removed. In postoperative course patient developed biloma in the site of liver injury which was successfully managed by interventional and endoscopic interventions. Patient is still alive and under active surveillance. Comments: The liver is one of the most frequently injured organs in penetrating gunshot injuries. Emergency laparotomy should be performed in hemodynamically unstable patient. In presented case a breast implant changed the pathway of the projectile and was probably the important reason of non-fatal outcome.
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