Delayed detection of a suicidal gunshot into the anterior skullbase

Introduction We describe the case of a patient with metastatic prostate cancer who underwent an unsuccessful suicide attempt with a firearm due to a pain exacerbation.

Case description An 89-year-old patient with multimetastatic prostate cancer presented to the urological ER due to massive pain in the thigh. He reported about a suicide attempt a few days ago, in which he had fired a shot in the right temple and another shot in the mouth with a 50-year-old pistol. The patient suspected that it must have been only practice ammunition, since his suicide was not successful. The clinical examination showed only abrasions on the temple, fibrin deposits on the hard palate and crusted blood around the nostrils. After ENT consultation, computed tomography of the paranasal sinuses and cranium was performed. CT revealed a projectile in the right sinus ethmoidalis and frontalis, directly adjacent to the anterior skullbase. There was no evidence of intracranial hemorrhage or other intracranial pathologies. The patient was admitted to the ENT ICU. In the course endoscopic sinus surgery was performed to remove the projectile.

Discussion The projectile was significantly slowed down in its strength by the hard palate and the bone at infundibulum of the frontal sinus. Furthermore, it is possible that the 50-year-old ammunition did no longer have sufficient power. Coclusion: Immediate CT imaging is highly recommended in unsuccessful suicides, even if there are no significant wounds or the type of projectile is unclear.

Publication History

Article published online:
12 May 2023