Case Report CASE ATTEMPTED SUICIDE UNEXPECTED IMRE
S HOTS the ported quences.
NO. 97
WITH GUNSHOT THROUGH THE LOCATION OF THE PROJECTILE M.D.,”
JBKABFI,
DEBRECEN,
MOUTH.
HUNGARY
from revolvers of appropriate caliber directed from the floor cranial base, as often seen in suicide, are usually lethal. The in which a patient with an injury of this kind survived without
of the mouth toward following ca8e is reconsiderable conse-
The patient, a man of 21 years, was mutilated during the war; he lost his left arm. He attempted suicide by means of a shot with a revolver directed into the region of his chin. After two’ trial shots, he pressed the orifice of the revolver to the region below his chin and fired. Surprisingly he did not lose consciousness, but there was bleeding of some duration and he swallowed some blood. After a few hours he called for assistance and was brought to our clinic. Below the chin, at the upper border of the hyoid bone in the median line, could be seen a gunshot wound. It was 1 cm. in diameter, of circular shape, and surrounded by a ring of soot and gunpowder granules. The surrounding tissues and the whole submental region were swollen and tender. In the base of the tongue, at a distance of 7 cm. from its tip, in the median line, a wound could be seen, which was of circular shape, 1 cm. in diameter, and covered by a grayish fur, surrounded by a hyperemic halo. A third wound was present in the soft palate, somewhat laterally from the insertion of the uvula; this was of lenticular shape and extent, with a yellowish-grayish fur, surrounded by a hemorrhagic and hyperemic halo. In the epipharynx, nasal cavity, and larynx no pathologic changes were found. The patient displayed severe aphonia, which may have been due to psychical shock as he regained his voice after he was told that, his throat was uninjured. The roentgenogram of the cranial base showed a slight impression of the clivus BlumenThe bullet was not seen in the head; it was found in bachii, but no other pathologic changes. the ileocecal region, lying supposedly in the cecum. By means of laxatives and a high enema the projectile was removed. It was of 9 mm. caliber, a lead bullet with a steel cover, and on its tip, corresponding to the impact with the bone, concentrical circular deformations could be seen. Except for minor suppuration of the skin, the patient recovered uneventfully and was dismissed from the clinic in three days. After penetration of the floor of the mouth, tongue, and soft palate, the living force of the bullet was not strong enough as to penetrate the massive bony resistance of the clivus. This may be due to a quantitative or qualitative insufficiency of the gunpowder. The projectile recoiled from the cranial base, impressing it slightly. Yet this impression was without Then passing the epipharynx and choanae it reached the any further clinical importance. oropharynx and was swallowed. SUMMARY of
A case has the importance
been reported of a thorough
Publication authorized Debrecen, Hungary. *Senior assistant of the
which is unique in medical literature. physical examination of every patient. by staff
the
Oto-Rhino-Laryngological
of the
Oto-Rhino-Laryngological 767
Clinic Clinic,
This
of
case
the
gives
proof
University
Debrecen,
Hungary.
in