Of 200 consecutive low-velocity abdominal gunshot wounds, 35 (17.5%) had nonpenetration of the peritoneal cavity as proved by celiotomy. Of these 35 patients, 30 (86%) did not have visceral injury while five sustained at least one visceral injury. Four of these patients sustained only minor visceral contusions not requiring surgical therapy. The fifth patient underwent exploration of an extraperitoneal bullet track with proof of peritoneal nonpenetration. The track passed beneath the deep fascia. This patient developed a jejunal perforation on the fourth hospital day and subsequently underwent celiotomy and repair. Thirty-four of our 35 patients with proven peritoneal nonpenetration did well with no surgical therapy, though penetration of the deep fascia with an intact peritoneum led to visceral injury in the case here reported.
Edwards J, Gaspard DJ. Visceral Injury Due to Extraperitoneal Gunshot Wounds. Arch Surg. 1974;108(6):865-866. doi:10.1001/archsurg.1974.01350300095022