Gunshot vaginal trauma

Abstract

Nonobstetric vaginal or vulva trauma is an extremely rare occurrence, with an incidence of < 0.2% of traumas. CT represents the gold standard in the diagnosis of gunshot lesions due to its ability to detect and stage injuries with very high sensitivity and specificity. A standardized protocol for penetrating trauma is still under debate for the use of intravenous contrast only or also rectal and oral contrast. Herein, we report a case of gunshot vaginal trauma in a 43-year-old patient presenting with vaginal bleeding. In our case, the protocol was "patient's tailored," the intravaginal selective use of air was administered due to symptoms (vaginal bleeding) and CT findings, this 2-step protocol increased diagnostic confidence and allow a correct and challenging diagnosis.

Keywords: CT protocol trauma; Gunshot injury; Penetrating trauma; Vaginal trauma.

Fig. 1

Axial CT scan during the pre-contrast phase showing (A) gunshot entry hole in the right gluteal region, (B) the retained bullet localized in the left coxofemoral subcutaneous region, (C) fragmented fracture of the left ischiopubic branch with evidence of multiple tiny bone pieces retained within the ipsilateral adductor muscles.

Fig. 2

Coronal three-dimensional volume-rendered image demonstrates the path of the bullet trajectory the fragmented fracture of the left ischiopubic branch and the retained bullet.

Fig. 3

(A–C) CT axial scan showing phase without contrast (A), during the arterial phase (B), the nephrographic phase (C) and delayed phase (D) demonstrating suprafluid-blood distention of the vagina and thickening and imbibition of the adjacent soft tissues.

Fig. 4

(A–D) CT axial and sagittal scan after the administration of Intravaginal positive contrast medium through a vaginal catheter demonstrates the extravasation of air and contrast confirming the diagnosis of a vaginal wound.