A Rare Bullet Trajectory: A Case Report of an Abnormal Gunshot Wound.

Gunshot wounds (GSWs) to the thoracic region are often associated with high mortality due to the injury of vital organs such as the heart, lungs, and aorta. Abnormal bullet trajectories complicate diagnosis and treatment, particularly when the bullet remains lodged within the body and no exit wound is present. This case report describes a rare instance of a gunshot wound entering through the anterior chest wall and ultimately lodging in the rectal region without an exit wound. Initial chest and abdominal imaging showed no acute pathology; however, advanced imaging, including contrast-enhanced abdominal and chest computed tomography (CT) scans, revealed that the bullet followed an atypical trajectory, traversing the small bowel, bladder, and pubic ramus before settling in the inferior ischioanal region. The patient underwent successful surgical intervention for both bowel and bladder injuries. This case highlights the importance of comprehensive secondary assessments, including advanced imaging, in identifying abnormal bullet trajectories and guiding appropriate management.