Abstract Ref Number = APCP1187
POST CRANIECTOMY DUE TO PENETRATING GUNSHOT WOUNDS IN FIVE YEARS MONITORING, A CASE REPORT
Indah Nur Lestari,Munar Lubis,Chairul Yoel,Rina A C Saragih,Gema N Yanni,Yunnie Trisnawati,Aridamuriany D Lubis,Ririe F Malisie,Badai B Nasution
Department of child health Faculty of medicine Universitas Sumatera Utara Department of child health Faculty of medicine Universitas Sumatera Utara
Background : Penetrating gunshot wound was caused by breaking projectiles in the cranium and it was type of traumatic brain injury which was the most common death cases in children after traffic accident. Incidence of peneterating gunshot wound in Asia 0.03 violent gun death per 100.000 cases. Neuropsychiatry disorder often happen in TBI children such as cognitive and behaviour disorder, depression and anxiety. Supportive and operative were management of TBI.
Case Presentation Summary : A 12 years old boy came with the main complain of decreasing conciousness. Previously, he was shot by a gun at a close range in the head by his friend whose father was a policeman. The bullet had inside over his front of head and perforated into the right back of the head. Vomitus, seizure and fever were found. From laboratorium result, we found mild anemia and leucocytosis. Head CT Scan result was extensive intracerebellar in fronto temporo parietal lobe, subarachnoid hemorrhage in cortical sulci of right temporoparietal and interhemisphere fissure, intraventricular hemorrhage in right lateral ventricle and interhemisphere fissure. There was foreign body inside his head and destruction in right frontal lobe. Management for his patient was ABC maintainance, reducing intracranial pressure and craniectomy. Craniectomy has been done by using bone and titanium substances during 2 years monitoring, 2013 - 2015. It was used for reducing intracranial pressure, hemorrhage and preventing infection in meningen. For nowadays, patient was in the third grade of senior high school. There was no impairment in behaviour, mental and emotional and neurology deficit by using Child Behaviour Checklist tool and Minnesota Multiphasic Personality Inventory. His Intelligence Quote (IQ) test was in normal range (99-104) by using Intelligence Structure Test.
Learning Points/Discussion : Penetrating gunshot wounds were one of TBI which caused death cases. The prognosis of penetrating gunshot wonunds depend on neurologic deficit, degree of brain damage and intracranial hemorrhage. In this patients came with somnolence and from Head CT Scan result was extensive, intracerebellar, subarachnoid, intraventricular hemorrhage. Comprehensive management of gunshot wound gave a good prognosis such as in this case.
Keywords: Prognostic Penetrating gunshot wounds Post Craniectomy Children