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A 34-year-old male soldier, worried about instructing his subordinates, shot himself by inserting the muzzle of a Howa Type 89 assault rifle with an adapter attachment for continuous fire into his mouth with a blank cartridge. When emergency medical technicians checked him, he was in a restless state and was transferred to our hospital. His medical and family history was unremarkable. Upon arrival, his Glasgow Coma Scale score was 15. He had a blood pressure of 144/98 mmHg, a heart rate of 74 beats/min, and a SpO2 of 100% with mask of 6 L/min of oxygen. The physiological findings revealed the presence of soot and multiple sites of minor bleeding at the soft and hard oral palate. Oral computed tomography (CT) demonstrated residual material from the blank shot [Figure 1]. Conservative treatment with an antibiotic agent was selected for residual material such as grenade fragments. There were no complications such as abscess formation, and he was discharged on the seventh hospital day.
To the best of our knowledge, this is the first CT image of residual material left behind by blank shot. Blank shot is typically used in gun-firing ceremonies and cinematography, and fatal accidents can occur in these situations. For example, a residual bullet accidentally left in the gun can be pushed out by the energy from the blank shot, causing fatal wounds. Alternatively, the energy created by the blank shot of itself can damage human tissue. When blank shot fired from a gun contacts the head, it can break the skull and damage the brain.[3,4] When blank shot fired from a gun contacts the chest, it can break the sternum and damage the lungs and heart. When blank shot is fired from a gun with its muzzle in the oral cavity, it can damage the tissues of the oral cavity, resulting in death due to deep aspiration of chyme with concurrent aspiration of blood. The present patient shot himself with a gun to which an adapter attachment had been fixed, thus weakening the energy created by the explosion of gunpowder. The residual materials observed in this case may be fragments of the capsule of the gun powder or the adapter attachment.
This manuscript received financial support from the Ministry of Education, Culture, Sports, Science and Technology (MEXT) - Supported Program for the Strategic Research Foundation at Private Universities, 2015–2019 concerning (the constitution of total researching system for comprehensive disaster, medical management, corresponding to wide-scale disaster).
There are no conflicts of interest.