|Year : 2012 | Volume
| Issue : 3 | Page : 195-196
Bronchopneumonia following abdominal firearm injury
Th Bijoy Singh1, Ng Taruni Devi2, N Nabachandra1
1 Department of Forensic Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
2 Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India, India
|Date of Web Publication||10-Jun-2013|
Th Bijoy Singh
Department of Forensic Medicine, Regional Institute of Medical Sciences, Imphal, Manipur
Source of Support: None, Conflict of Interest: None
DOI: 10.4103/0972-4958 .113252
A man sustained firearm injury in the abdomen and later on died due to bronchopneumonia following postoperative complications. This case is being reported to establish the importance of Medical Audit Sessions to improve patient care service in the hospital.
Keywords: Bronchopneumonia, Firearm, Negligence
|How to cite this article:|
Singh T, Devi N, Nabachandra N. Bronchopneumonia following abdominal firearm injury. J Med Soc 2012;26:195-6
| Introduction|| |
A case of firearm victim who died in the hospital due to bronchopneumonia is reported here. The negligence involved in the management resulting death due to complications is highlighted. It is to establish the importance of Medical Audit Sessions to improve patient care service in the hospital.
| Case Report|| |
A man sustained firearm injury on 16.05.2000 at about 4.45 p.m. allegedly by unknown armed youth. He was hospitalized at Regional Institute of Medical Sciences (RIMS) Hospital at about 4.55 p.m. of the same day and died on 21.05.2000 at 4.45 a.m. Postmortem examination was carried out on the dead body on 21.05.2000 at 10 a.m. at RIMS mortuary.
On examination, the following findings were noted: Stature: 6'1", weight: 82 kg, cyanosis present, rigor mortis developed all over the body, postmortem staining present on back and not fixed. White froths present in the nostrils.
- Entrance wound of firearm measuring 3.5 × 1.5 cm in area with blackening and scorching around the margin present on the outer aspect of left side abdomen situated 15 cm from midline and 6 cm above anterior superior iliac spine. The divergent track passed downward and inward perforating the abdominal wall, peritoneum, sigmoid colon, and ended blindly in the peritoneal cavity.
- Surgical wound (colostomy) present on the left iliac fossa measuring 6 × 4 cm in size. Wound margins were healthy and healing.
- Longitudinal stitched surgical wound on anterior abdominal wall in midline extending from epigastric region to suprapubic area 24 cm in length. Wound margins healing and healthy.
Histopathological report (Histo No. PM-22/00, dated 29.5.2000).
- Meninges and brain were found congested, weight of the brain was 1350 g.
- Trachea and bronchi were found congested and white froth present in the lumen. Pleura congested right lung congested and edematous, 600 g in weight. Left-lung was congested and edematous, 500 g in weight.
- Heart was congested, 340 g in weight.
- In large intestine (sigmoid colon), colostomy wound and stitched surgical wound were present and healthy.
- Lung tissue: Whitish area with lung tissue.
- Intestinal tissue: Cross-section showed greenish mucoid material in the lumen staining with mucosa.
Cause of death
- Section from the lungs shows features of bronchopneumonia.
- Sections from the intestine show no sign of pathology.
Death was due to bronchopneumonia resulting from postoperative complication of firearm injury over abdomen.
As shown in [Table 1], monitoring of serum electrolyte showed hyperkalemia.
X-ray chest (20.5.2002): Shows bilateral patchy consolidation
Which is consistent with bilateral chest infection.
Important Clinical Information
- Past history of bronchial asthma.
Surgical laparotomy along with sigmoid colostomy was carried out on 16.5.2000. This was followed with usual postoperative managements. A bronchodilator was also given (from 19.5.2000) and patient was also referred to a physician for complain of difficulty in breathing. The condition of the patient was deteriorated and expired on 21.5.2000 at about 4.45 a.m.
| Discussion|| |
The autopsy revealed the cause of death as bronchopneumonia, which was supported by the histopathology and not due to fire arm injury. Most cases of pneumonia in the medical examiner's office are secondary to other causes of death, such as coma due to accidental or homicidal head trauma.  Sudden death can, however, occur in cases of primary pneumonia, but this is relatively uncommon as most individuals with pneumonia are under a doctor's care.  However, in this case, it seems that a reasonable care is lacking on the part of the treating doctors. As shown in [Table 2], there was overloading of fluid, but sincere attempt to correct the fluid appears to be lacking. As shown in [Table 1], monitoring of serum electrolyte showed hyperkalemia, which was not corrected? Hyperkalemia is a frequent cause of arrhythmias and this might have worsened the condition.
There is overloading of fluid as shown by intake and output chart. On certain day the overloading was as high as about 3 l. Fluid overload per se will impair the gas exchange through the lung, over and above the patient had history of bronchial asthma and the diseased lung is more prone to infection.
Regular monitoring of serum electrolytes was not carried out and hyperkalemia developed. The patient was referred to a physician only on 19.5.2000 though the patient gave history of bronchial asthma.
In spite of all the above management procedures the patient died.
In modern day, medical practice is becoming more technical and mechanical and less personal.  If a doctor in the course of his treatment or operation, if he fails to exercise the reasonable skill and care expected of a reasonably competent doctor at the time, he becomes liable to be charged with negligence, if his patient is injured as a result of his treatment or operation. 
An action for negligence may be brought against a medical practitioner in a civil or criminal court.  The case is interesting because of the fact that the patient died not because of the firearm wound but because of postoperative complications. Postoperative pneumonitis is not an uncommon complication, however, it may be emphasized that in the present case there appears to be certain room in the treatment procedures, which could be improved upon.
Medical Audit Sessions will definitely help in improving patient care service in the hospital. This case is reported to have a better health care delivery system in our set up like RIMS, Imphal.
| References|| |
|1.||Dimio VJ, Dana ES. Natural disease. Handbook of Forensic Pathology. 1 st ed. Landes Bioscience,Viva Books Private limited, Daryaganj, New Delhi; 1999. p. 52-3. |
|2.||Gupta BD. The Indian Medical Council (professional conduct, etiquette and ethics) regulations, 2002, critical review and suggestions. Indian J Forensic Med Toxicol 2003;20:4-5. |
|3.||Mehta HM. Medical law and ethics in India. 1 st ed. Mumbai: The Bombay Samachar Pvt. Ltd.; 1963. p. 76. |
|4.||Subhramanyam BV. Law in relation to Medical Men. Modis Medical Jurisprudence and Toxicology. 22 nd ed. New Delhi: Butterworths India Ltd.; 1999. p. 705. |
[Table 1], [Table 2]