Which Management for Gunshot Chest Wounds in a War Zone Hospital?


War surgery
Thoracic trauma
Penetrating wound
Gunshot wound
Thoracic drainage

How to Cite

Abdoulaye MB, Ousseini A, SANI R, SANI R. Which Management for Gunshot Chest Wounds in a War Zone Hospital?. ATD [Internet]. 2021 Jan. 11 [cited 2023 Sep. 22];2021. Available from: https://mbmj.org/index.php/atd/article/view/243


Introduction:  Gunshot chest wounds are a life-threatening surgical emergency without immediate management. Method: The study period is two years, covering cases admitted from June 2017 to May 2019. The surgical service of the regional hospital center (CHR) of Diffa in Niger is one of the main second-level referral structures where victims of the armed conflict that started in 2014 in the Lake Chad basin are referred and treated. Through this study, we report the preliminary results of the hospital management gunshot chest. Results: Firearm-related chest wounds accounted for 9.22% of firearm injury admissions, interesting especially for young man subjects. Penetrating thoracic lesions involved 14 patients, 12 of whom had high and medium-abundant effusion treated by thoracic drainage. Two patients had a pulmonary contusion and a fatal tamponade pattern respectively. Conclusion: Emergency chest drainage is a first-line saving procedure in the treatment of thoracic wounds with firearms in armed conflict.



MacKenzie EJ. Epidemiology of injuries: current trends and future challenges. Epidemiol Rev. 2000;22(1):112-9. https://doi.org/10.1093/oxfordjournals.epirev.a018006

LoCicero J 3rd, Mattox KL. Epidemiology of chest trauma. Surg Clin North Am. 1989 Feb;69(1):15-9. https://doi.org/10.1016/s0039-6109(16)44730-4

Von Oppell UO, Bautz P, de Groot M. Penetrating thoracic injuries: what have learnt. Thorac Cardiovasc Surg. 2000 Feb;48(1):55-61. https://doi.org/10.1055/s-2000-8891

Boddaert G, Mordant P, Le Pimpec-Barthes F, Martinod E, Aguir S, Leprince P, et al. Surgical management of penetrating thoracic injuries during the Paris attacks on 13 November 2015. Eur J Cardiothorac Surg. 2017 Jun 1;51(6):1195-1202. https://doi.org/10.1093/ejcts/ezx036

Lerer LB, Knottenbelt JD. Preventable mortality following sharp penetrating chest trauma. J Trauma. 1994; 37(1):9–12. https://doi.org/10.1097/00005373-199407000-00003

Hardcastle TC, Finlayson M, van HM, Johnson B, Samuel C, Muckart DJ. The prehospital burden of disease due to trauma in KwaZulu-Natal: the need for Afrocentric trauma systems. World J Surg. 2013; 37(7):1513–1525. https://doi.org/10.1007/s00268-012-1852-1

James Didier L, Rabiou S, Chaibou MS, Adamou H, Younssa H, Ousseini A, et al. Résultats de la prise en charge des plaies thoraciques à l’hôpital National de Niamey, Niger. RECAC. 2017; 2(12): 19-24.

Nicol AJ, Edu S, Navsaria P. Selective operative management of penetrating chest Injuries. Curr Surg Rep. 2019; 7(6):1-6. https://doi.org/10.1007/s40137-019-0233-1

Van Waes OJF, Halm JA, Van Imhoff DI, Navsaria PH, Nicol AJ, Verhofstad MHJ, et al. Selective nonoperative management of penetrating thoracic injury. Eur J Emerg Med. 2018 Feb;25(1):32-38. https://doi.org/10.1097/mej.0000000000000401

de Lesquen H, Beranger F, Berbis J, Boddaert G, Poichotte A, Pons F, et al. Challenges in war-related thoracic injury faced by French military surgeons in Afghanistan (2009–2013). Injury. 2016 Sep;47(9):1939-44. https://doi.org/10.1016/j.injury.2016.06.008

Oparah SS, Mandal AK. Penetrating gunshot wounds of the chest in civilian practice: experience with 250 consecutive cases. Br J Surg. 1978 Jan;65(1):45-8. https://doi.org/10.1002/bjs.1800650113

Borja AR, Ransdell HT. Treatment of penetrating gunshot wounds of the chest. Experience with one hundred forty-five cases. Am J Surg. 1971 Jul;122(1):81-4. https://doi.org/10.1016/0002-9610(71)90354-0

Muckart DJ, Meumann C, Botha JB. The changing pattern of penetrating torso trauma in KwaZulu/Natal – a clinical and pathological review. S Afr Med J. 1995 Nov;85(11):1172-4.

Kong VY, Sartorius B, Clarke DL. The selective conservative management of penetrating thoracic trauma is still appropriate in the current era. Injury. 2015 Jan;46(1):49-53. https://doi.org/10.1016/j.injury.2014.07.011

Doll D, Eichler M, Vassiliu P, Boffard K, Pohlemann T, Degiannis E. Penetrating thoracic trauma patients with gross physiological derangement: A responsibility for the general surgeon in the absence of trauma or cardiothoracic surgeon? World J Surg. 2017 Jan;41(1):170-175. https://doi.org/10.1007/s00268-016-3703-y

Siemens R, Polk HC Jr, Gray LA Jr , Fulton RL. Indications for thoracotomy following penetrating thoracic injury. J Trauma. 1977 Jul;17(7):493-500. https://doi.org/10.1097/00005373-197707000-00002

Boyd AD, Glassman LR. Trauma to the lung. Chest Surg Clin N Am. 1997 May;7(2):263-84.

Keneally R, Szpisjak D. Thoracic trauma in Iraq and Afghanistan. J Trauma Acute Care Surg. 2013 May;74(5):1292-7. https://doi.org/10.1097/ta.0b013e31828c467d

Durso AM, Caban K, Munera F. Penetrating thoracic injury. Radiol Clin North Am. 2015 Jul;53(4):675-93, vii-viii. https://doi.org/10.1016/j.rcl.2015.02.010

Cerf C. Pulmonary contusions: physiopathology and management. Réanimation. 2007 ; 16:82–87.

Michelet P, Couret D, Brégeon F, Perrin G, D'Journo XB, Pequignot V, et al. Early onset pneumonia in severe chest trauma: a risk factor analysis. J Trauma. 2010 Feb;68(2):395-400. https://doi.org/10.1097/ta.0b013e3181a601cb

Raghavendran K, Notter RH, Davidson BA, Helinski JD, Kunkel SL, Knight PR. Lung contusion: inflammatory mechanisms and interaction with other injuries. Shock. 2009 Aug;32(2):122-30. https://doi.org/10.1097/shk.0b013e31819c385c

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2021 Maman Bachir A et al.


Metrics Loading ...