From the Guidelines
A gunshot wound to the left 10th rib would most likely affect the spleen, which is located in the left upper quadrant of the abdomen beneath the diaphragm and protected by the lower ribs. The spleen is particularly vulnerable to injury at this location because it sits adjacent to the 9th, 10th, and 11th ribs on the left side 1.
Possible Injuries
- The left kidney, left lobe of the liver, stomach, and possibly the left lung (especially if the bullet trajectory is upward) could be injured depending on the exact angle and depth of penetration.
- The descending colon and pancreatic tail might also be at risk.
- This type of injury requires immediate medical attention as damage to the spleen can cause significant internal bleeding, potentially leading to hemorrhagic shock, as defined by hemodynamic instability with an admission systolic blood pressure < 90 mmHg or requiring bolus infusions/transfusions and/or vasopressor drugs 1.
Treatment Considerations
- Treatment typically involves surgical exploration, possible splenectomy (removal of the spleen) or splenic repair, and management of any associated injuries to surrounding structures.
- The use of CT helps in surgical procedure and in angioembolization (AG)/arterial embolization (AE) to be more selective, especially in cases with active contrast extravasation, which is a sign of active hemorrhage 1.
- Wound exploration near the inferior costal margin should be avoided if not strictly necessary because of the high risk to damage the intercostal vessels 1.
From the Research
Organ Affected by Gunshot Wound to the Left 10th Rib
- The organ affected by a gunshot wound to the left 10th rib is likely to be the spleen, as left-sided rib fractures have been associated with an increased risk of splenic injury 2, 3.
- A study published in the American Journal of Surgery found that left middle segment rib fractures and lower segment rib fractures had sensitivities of 80% and 63% for splenic injury, respectively 2.
- Another study published in The Journal of Trauma found that the probability of splenic injury increased with the presence of left-sided rib fractures, low rib fractures, young age, and an elevated Injury Severity Score 3.
- It is essential to note that the estimation of bullet trajectory and the assessment of internal injuries should be based on objective clinical and diagnostic findings, rather than relying solely on the location of the rib fracture 4.