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Table of Contents   
CASE REPORT
Year : 2023  |  Volume : 28  |  Issue : 5  |  Page : 442-444
 

Air gun injuries in children – A near miss!


1 Department of General Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
2 Department of Pediatric Surgery, Father Muller Medical College, Mangalore; Department of Pediatric Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
3 Department of Pediatrics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
4 Department of Paediatric Surgery, Regional Advanced Paediatric Care Centre, Wenlock District Hospital, Mangalore, Karnataka, India

Date of Submission06-Apr-2023
Date of Decision04-Jun-2023
Date of Acceptance23-Jun-2023
Date of Web Publication05-Sep-2023

Correspondence Address:
Sowmini Padmanabh Kamath
Department of Pediatrics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.jiaps_75_23

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   Abstract 


Air guns that are employed for protection and entertainment/sporting events can have accidentally harmful consequences. We report three examples of air gun injuries in the pediatric population with injuries, which could be potentially fatal.


Keywords: Child, firearms, gunshot, wounds


How to cite this article:
Girish T, Joshi J, Kamath SP, Rao S. Air gun injuries in children – A near miss!. J Indian Assoc Pediatr Surg 2023;28:442-4

How to cite this URL:
Girish T, Joshi J, Kamath SP, Rao S. Air gun injuries in children – A near miss!. J Indian Assoc Pediatr Surg [serial online] 2023 [cited 2023 Oct 2];28:442-4. Available from: https://www.jiaps.com/text.asp?2023/28/5/442/385150





   Introduction Top


Air guns can be potentially dangerous due to their widespread use in farms to frighten away wild animals and in sports and entertainment. Limited laws regulating air gun use, use by untrained individuals, and myths regarding their safety have made them commonly available in both the West and in traditional Indian homes with farms.

There are previous reports of pediatric air gun injuries,[1],[2],[3] but sparse in the Indian context. We report three cases of accidental air gun injuries in children, with an irony of a near miss.


   Case Reports Top


These three children sustained bullet injuries due to the accidental triggering of air guns during cleaning for regular maintenance by parents.

Case 1

A 5-year-old girl arrived with an alleged history of abdominal air gun injury. The entry point [Figure 1]a was in the left periumbilical region (0.5 cm × 0.5 cm erythematous-raised lesion) with no active bleeding or hemodynamic instability. The erect abdominal radiograph showed a radiopaque object close to the left sacroiliac joint with no evidence of free air under the diaphragm [Figure 1]b. Contrast-enhanced computed tomography (CECT) of the abdomen showed the pellet to have lodged itself into the left psoas major muscle, with hemoperitoneum and pneumoperitoneum [Figure 1]c. Intraoperatively, we found multiple jejunal perforations closed primarily [Figure 1]d and the pellet [Figure 1]e in the left psoas muscle, close to the left ureter and iliac vessels.
Figure 1: Clinical, imaging, and surgical details of Case 1. (a) Entry wound over the abdomen (black arrow), (b) erect X ray of the abdomen showing pellet close to the left sacroiliac joint (white arrow), (c) contrast enhanced computed tomography of the abdomen and pelvis showing the pellet at the S1 vertebral level, abutting the left psoas muscle (black arrow), with evidence of hemopneumoperitoneum, (d) intraoperative finding of jejunal perforation (circle), (e) the pellet retrieved

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Case 2

A 9-year-old girl presented to the emergency with a history of air gun injury to the neck. The entry wound was 5 cm lateral and 2 cm inferior to the symphysis menti on the right side of the neck [Figure 2]a. She was clinically stable. The pellet was in the right parapharyngeal region [Figure 2]b close to the neck veins on CECT imaging. The bullet was surgically recovered [Figure 2]c and [Figure 2]d with no injuries to the trachea, esophagus, or other vital structures.
Figure 2: Clinical, imaging, and surgical details of Cases 2 and 3. Case 2 (a) entry wound noted in the right side of the neck( black arrow), (b) contrast enhanced computed tomography of the neck showing the pellet in the right parapharyngeal space (white arrows), (c) intraoperative finding of the pellet in the right parapharyngeal space in close relation to the trachea and esophagus (black arrow), (d) the pellet retrieved, Case 3 (e) computed tomography three dimensional reconstruction showing the pellet in the right axilla, close to the neurovascular structures(white arrow)

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Case 3

A 9-year-old girl presented with a right axillary air gunshot injury. The entry point was a 0.5 cm × 0.5 cm reddish, elevated lesion on the proximal right arm's medial aspect close to the anterior axilla [Figure 2]e. Computed tomography three-dimensional reconstruction identified the pellet in the intramuscular plane, adjacent to the brachial plexus and axillary vessels, with absent contrast extravasation, and was recovered by computer-assisted radio monitoring.

All three had uneventful recoveries.


   Discussion Top


Our patients sustained injuries from the accidental firing of air guns during maintenance at their residences. Air guns have an average muzzle energy of 8–20 J and a velocity of 70–220 m/s capable of penetrating the skin and causing severe injury in children. Their use in an Indian setup is to scare off wild animals.

The pellets penetrated proximity to vital structures such as the ureters, iliac vessels, trachea, esophagus, brachial plexus, axillary, and carotid vessels with no obvious injury to these structures and, thus, were not life-threatening.

Previous reports of pericardial injuries,[1] aortic lacerations,[2] and a review[3] have been described. However, reports from India are few,[4] which may be due to underreporting.

In most nations, the Arms Act does not control the use of air weapons, with no age restrictions. The Indian Arms Act, 1959, and the 2016 amendment (Arm Regulation)[5] do not require a license permit for the purchase and use of air pistols with muzzle energies <20 joules or bores <4.5mm (0.177 inches).

Even though our patients sustained injury due to accidental firing, the wounds were near critical anatomical areas indicating that these could be as catastrophic as those caused intentionally. Education regarding the careful use of these weapons, awareness among parents and leaders of the nation, and appropriate rules and regulations concerning the usage of air guns are needed.

Successful management of pediatric air gun injuries requires a multidisciplinary team consisting of legal experts, pediatric surgeons, pediatricians, anesthesia, and nursing staff.

To conclude, air gunshot wounds are potentially dangerous. A careful examination of the entry point and tracing the trajectory radiologically aid in the management. In our patients, the trajectory of the pellets missed the vital structures, hence avoiding the potential morbidity or mortality.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published, and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed.

Acknowledgments

We thank the children and the parents who consented to treatment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Polak R, Vodicka J, Treska V, Siroky J, Benes J. Air gun injury to the pericardium in a 9-year-old boy. Ulus Travma Acil Cerrahi Derg 2022;28:1641-4.  Back to cited text no. 1
    
2.
Sunderland M, Lafranchise E, Durrant A. Pediatric Aortic Injury From a BB Gun Injury Requiring Emergent Thoracotomy. Am Surg. 2022 Apr 21:3134820971575. doi: 10.1177/0003134820971575.  Back to cited text no. 2
    
3.
Apelt N, Greenwell C, Tweed J, Notrica DM, Maxson RT, Garcia NM, et al. Air Guns: A Contemporary Review of Injuries at Six Pediatric Level I Trauma Centers. J Surg Res. 2020 Apr; 248:1-6. doi: 10.1016/j.jss.2019.11.002.  Back to cited text no. 3
    
4.
Sharma R, Chaturvedi V, Jangid N, Ojha S. Air Gun Bullet Related Lung Injury. Pediatr Oncall J. 2020;17: 121-123. doi: 10.7199/ped.oncall.2020.40.  Back to cited text no. 4
    
5.
National Rifle Association of India. Arms Rules 2016 as amended by GSR 1342 (E);2016. Available from https://www.thenrai.in/PDF/ed3503ce-c32d-4d97-8dfe-887ec49fd55c.pdf. [Last accessed on 2023 Mar 15].  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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