Penetrating Thoracoabdominal Gunshot Injury With Gastric Perforation and Sequential Bilateral Tube Thoracostomy: A Case Report

A 71-year-old male presented approximately 22 hours after sustaining two thoracoabdominal gunshot wounds.Despite preserved hemodynamic stability, peripheral oxygen saturation fluctuated between 92% and 96% on room air, accompanied by mild tachypnea, increased work of breathing, dyspnea with minimal exertion, and bilateral abnormalities on chest examination.Sequential bilateral tube thoracostomy was primarily guided by clinical examination findings.Admission abdominal computed tomography (CT) demonstrated pneumoperitoneum and a 63 × 52 mm perigastric gas-fluid collection, prompting urgent laparotomy despite absent peritoneal signs.Surgery revealed free gastric fluid and food debris dispersed in the perigastric region, associated omental injury, and a single 1.0-1.5 cm anterior gastric wall perforation near the greater curvature.The gastric perforation was repaired using a two-layer closure reinforced with an omental patch.An intraoperative methylene blue leak test was negative, and the peritoneal cavity was irrigated.Follow-up chest CT after drainage demonstrated small residual bilateral pneumothoraces.The patient was discharged after 10 hospital days and had no identified postoperative complications at shortterm outpatient follow-up approximately 15 days after discharge.This case emphasizes integrated thoracic and abdominal assessment in delayed penetrating trauma and the risk of significant visceral injury despite initially preserved hemodynamics.