Various terms used: BB gun, air rifle, air gun, pellet gun, multiple pump air gun
Potential pitfalls in the diagnosis:
(1) Failure of parents and providers to understand the potential seriousness of a penetrating abdominal wound from an air gun.
(2) Lack of external signs suggesting significant injury.
(3) No clinical signs of peritoneal irritation on presentation to the Emergency Department.
Recommendations for managing a patient with an air gun wound to the abdomen:
(1) The patient should be completely evaluating if there is a penetrating wound to the abdomen from a multi-pump air gun at a distance of < 10 feet. The risk drops if the distance is from 10-20 feet, with abdominal injury rare if the distance > 20 feet.
(2) Immediate abdominal celiotomy presentation if the patient develops hypotension, peritoneal signs, bleeding or other signs of vascular or hollow viscus injury.
(3) If an abdominal radiograph shows an intra-abdominal BB or pellet then either
(3a) immediate celiotomy is performed regardless of clinical findings.
(3b) the patient is carefully for observed with serial examinations and surgery is performed if signs of peritoneal irritation occur.
