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Old 06-02-2011, 09:36 AM   #1
S.A.Michel
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Abdominal Gunshot Wound Recovery

For a WIP of mine (well, obviously...) there's a character who gets shot in the abdominal area... She's left to die (would it be possible to intentionally shoot in an attempt to avoid internal organs for her to simply [and painfully] bleed to death?), but is actually found not long after and taken to surgery. Supposing she survives this, how long would recovery take? I mean all the way from the wound healing to physical therapy (It's kind of relevant to the story that she can't do the things she was used to physically... she was very skilled at acrobatics and fighting, but now she can't do it because of pain from the wound... is that realistic? Would such wound leave her permanently impaled impared?)

By the way, the character is around 18 years old and a female... Very good physical condition prior to (as mentioned above).

»Sam.

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Old 06-02-2011, 12:39 PM   #2
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Some people say that a bullet in the actual stomach is an absolute, irrevocable death sentence but apparently it isn't.

People can survive such wounds - these days at least.

General abdominal wounds can be survived as well. It depends.

Permanently impaled means that you have a long, sharp object penetrating your body at all times.
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Old 06-02-2011, 06:32 PM   #3
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Quote:
permanently impaled
Ahem, I think you mean permanently impaired.

Part if it could depend on how good a physical therapist she has, how much she pushes herself immediately after the surgery, whether or not she pushes too hard and re-injures herself, etc. Even if everything goes right, she's going to lose a lot of flexibility and muscle tone, which will take time to rebuild and which might never reach the levels where they were before her accident. I broke my foot at 18, playing soccer, and have never been able to return to my pre-injury skill level (though part of that is b/c of later injuries and part of that is b/c my life/job doesn't depend on it).

If the surgeons and physical therapists have done their job right, she shouldn't be in tons of pain years after the injury. I'll leave it to the real medical folks to talk about damaged organs and stuff, but I do at least know adhesions can be fixed if they're dealt with right away, or fixed surgically later.

From what it sounds like you want (I'm guessing by how you phrased your question), you might be better off setting the story a few months after the injury (say 3-ish) when she's getting to the point of functioning in 99% of situations that a normal person would ever be in, but isn't 100% recovered by her own standards. It's one of the more annoying parts of p.t. b/c you're impatient to be better already and you can push yourself too hard (and set yourself back) b/c of that impatience.

Now if you'll excuse me, I'm off to physical therapy...

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Old 06-02-2011, 06:34 PM   #4
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It's really going to depend on what the bullet goes through, as well as the type of gun, bullet, speed, and the distance fired. A shotgun might cause a ton more damage than a single shot from a handgun. Either way, there's lots of lovely vital organs to rupture down there. She could survive if she was really lucky and the bullet miraculously lodged/ripped through somewhere not too damaging or if she did manage to get immediate medical attention and get into surgery.

Bleeding to death wouldn't be the only concern. The bullet could rupture the stomach, and then all that acid would leak out and finish the job in the worst way possible. Or it could rip through the intestines or bowel and cause some really nasty infection.

The length of recovery would, again, depend on the amount of damage. Uh...I haven't ever seen an abdominal shooting (really hope that doesn't jinx me when I work at the ER next year), buuut someone asked a similar question over here that might be helpful: http://boards.straightdope.com/sdmb/...d.php?t=368301
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Old 06-03-2011, 01:01 AM   #5
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Originally Posted by Sammychel View Post
For a WIP of mine (well, obviously...) there's a character who gets shot in the abdominal area... She's left to die (would it be possible to intentionally shoot in an attempt to avoid internal organs for her to simply [and painfully] bleed to death?), but is actually found not long after and taken to surgery. Supposing she survives this, how long would recovery take? I mean all the way from the wound healing to physical therapy (It's kind of relevant to the story that she can't do the things she was used to physically... she was very skilled at acrobatics and fighting, but now she can't do it because of pain from the wound... is that realistic? Would such wound leave her permanently impaled?)

By the way, the character is around 18 years old and a female... Very good physical condition prior to (as mentioned above).

»Sam.
Shooting someone with a handgun* in order to make them bleed to death is not a good idea. A 9mm bullet might drift five inches sideways on it's way through the torso and if it hits bone even more so.

If you shoot her through the guts, she will most likely be incapacitated by pain, and there will be a lot of blood. the attacker might well believe that she will bleed out if left alone.

(Note "Will" below should be read "depending on the exact circumstances odds are between zero and one hundred")


A gunshot through the lower abdomen will tear through muscle and intestines, possibly cutting arteries. Intestinal bacteria will enter the blood stream causing sepsis and inflammation. If the bullet is a large caliber hollow point, the exit wound will be large and some muscle will be destroyed.

With regards to the degree of impairment, that varies dramatically. A strong willed person with good basic health and access to therapy and luck might recover to the point that only they notice some movement loss or pain. Others might have permanent disabilities from even a small wound, such as nerve damage, phantom pains, cramps, secondary infection might make it necessary to remove muscle or intestines.

You can pick whatever you feel is ok for the story, because all of it might happen.

*If you decide to use a rifle like a 7.62NATO or .30-06, the above is aggravated by several magnitudes. Rifles are VERY much more deadly than hand gins. If you elect to use one of them, I would suggest a protective vest to slow the bullet a bit before penetration.
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Old 06-04-2011, 06:54 AM   #6
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Quote:
Originally Posted by Sammychel View Post
For a WIP of mine (well, obviously...) there's a character who gets shot in the abdominal area... She's left to die (would it be possible to intentionally shoot in an attempt to avoid internal organs for her to simply [and painfully] bleed to death?), but is actually found not long after and taken to surgery. Supposing she survives this, how long would recovery take? I mean all the way from the wound healing to physical therapy (It's kind of relevant to the story that she can't do the things she was used to physically... she was very skilled at acrobatics and fighting, but now she can't do it because of pain from the wound... is that realistic? Would such wound leave her permanently impaled?)

By the way, the character is around 18 years old and a female... Very good physical condition prior to (as mentioned above).

»Sam.
Although anything basically is possible, no it is not realistic. As far as athletics go, your internal organs although vital for getting nutrition and oxygen to the muscles and bones, are sort of along for the ride. In the big scheme of things, injuries to them are things that either you recover from or don't and there isn't much for a physical therapist to do for a patient after abdominal surgery. If you want an injury that will slow the character down permanently and require a physical therapist to be on board, then you want bone and skeletal muscle injuries plus maybe peripheral nerve damage. A bullet to the hip will have far longer term implications than one to the belly. As far as recouperation from major abdominal surgery goes the average is 6 weeks to no longer require pain meds, but a lot of feeling tired with all manner of vague aches for 1-2 years. Serious training is unusual in less than 3-6 months post op even for people like Lance armstrong. IIRC I think I read that he took a year or 2 off but he also had chemo and radiation, not just surgery.

Last edited by GeorgeK; 06-04-2011 at 07:07 AM.
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Old 06-05-2011, 02:32 AM   #7
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Quote:
Originally Posted by Sammychel View Post
Would such wound leave her permanently impaled?
Permanently impaled! You made my day.

Medically, things are unpredictable. Everyone's body is different. One may survive something while someone in the same circumstance might die. It also depends on how someone is physiologically. An 18 year old might say, 'there's no way in hell I'm going to die. I'm too young!' Where someone elderly will say 'I lived my life; it's not worth the pain. Let me die.'

I was actually going through some old notes from someone's medical records. They were deceased and I was to take the chart down to the basement. I read in the Dr.'s notes that the elderly woman on dialysis didn't want to live anymore and even though they brought a physiologist in, she wound up dying a few days later.

I was also talking to a CNA and she said when she was working in the E.R. a drunk woman had fallen at home. She grabbed her table to try and catch herself, but instead she grabbed the glass top and pulled it against her abdomen. She came in, the glass had cut her so deep that her insides were hanging out and the only thing she complained about was the blood pressure cuff being too tight. Her she is, almost disemboweled, and the only thing that's causing her pain was the blood pressure cuff.

Medicine is crazy, unpredictable, and very subjective. What works for one person won't necessarily work for the next. So with your character, if you want her to live, then let her live. If you have an idea of recuperation time, then go for it. Anything is plausible in medicine.
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