European Journal of Trauma and Emergency Surgery
Case Report
Blunt Liver Trauma from Bean Bag Ammunition Misha D.P. Luyer, Anton G.M. Hoofwijk1
Abstract Police departments in Europe are increasingly using nonlethal weapons and/or ammunitions such as a bean bag to restrain and disable a person temporarily. A bean bag is a small nylon bag filled with metal balls that is fired from a shotgun and weighs approximately 50 g. It is successfully used in the United States by law enforcement personnel. This report describes a case in which use of a bean bag resulted in a contusion of the liver, which was treated conservatively. Key Words Bean bag Æ Intra-abdominal injury Æ Liver contusion Eur J Trauma Emerg Surg 2009;35:503–4 DOI 10.1007/s00068-008-8059-z
Introduction Nonlethal weapons and/or ammunitions such as a bean bag are frequently being used by police departments to restrain and control a person temporarily. A bean bag or stun bag is a nylon bag filled with small metal balls that is fired from a shotgun. It is designed to be shot with a riot gun at several meters and to produce a blunt trauma resulting in substantial pain, thus incapacitating the offender.
Case Report A 46-year-old man was brought to the emergency room under police guidance after being arrested and restrained by a bean bag several hours before. The patient had a normal level of consciousness, was not hostile, and reported extreme pain on his right lower thorax, at the site of impact. On physical examination his vital signs were within the normal range and he had
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a sharp contusion with hematoma and swelling on the right lower thorax with a diameter of approximately 4 cm (Figure 1). Breath sounds were normal, and there was no evidence of deformity, subcutaneous air, or crepitus. Abdominal examination showed no palpable masses, and there were no signs of an acute abdomen. The patient was hemodynamically stable and laboratory investigation showed a normal hemoglobin level (9.1 mmol/l). A subsequent CT scan of the thorax and abdomen showed a contusion of segment IV of the liver (Figure 2). He was treated conservatively with analgesia and observed for one day.
Discussion Bean bags have successfully been used for many years by US law enforcement and are intended to disable a person temporarily, thus allowing law enforcement personnel to safely disarm and control a person. These weapons are only deployed in situations in which a lethal weapon would normally be fired, and they need to be fired at a distance of several meters. Because of the shape and size of a bean bag, the kinetic energy is spread over a larger surface area, thereby reducing the amount of injury to the individual. Although this weapon is considered to be nonlethal or less lethal, several reports of significant injury following its use have been published in the US [1–3]. Risk factors for serious injuries include multiple shots and close-range shots. To minimize trauma, the shape and size of the bean bag has since been modified. Such a modified type of bean bag (type DS 23) was fired from a 12 mm caliber riot gun (Mossberg, type 590) according to police guidelines. The individual was not especially protected by armor and wore normal clothes at the time. Advances in nonlethal technology and changing requirements from police forces have increased the use
Department of Surgery, Maasland Hospital Sittard, Sittard, The Netherlands.
Received: April 23, 2008; revision accepted: October 17, 2008; Published Online: December 19, 2008
Eur J Trauma Emerg Surg 2009 Æ No. 5 Ó URBAN & VOGEL
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Luyer MDP, Hoofwijk AGM. Blunt Liver Trauma from a Bean Bag Ammunition
are being developed, using acoustic or electroshock properties [4]. These developments require awareness about the existence of such weapons and insight into the physical injuries they may inflict, and they will result in new challenges for trauma surgeons and other medical personnel that come into contact with these victims. When these nonlethal weapons are introduced, one could argue that any person who comes into contact with such a weapon should undergo medical examination to exclude physical injury.
Figure 1. A sharp contusion with hematoma and swelling on the right lower thorax with a diameter of approximately 4 cm.
Conclusion This case shows that a nonlethal weapon such as the bean bag can cause substantial physical injury. Trauma surgeons need to be aware of these weapons and the potential harm they may inflict.
References 1.
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Figure 2. CT scan in arterial phase at which a contusion in segment IV of the liver is seen with a subcutaneous swelling (white arrows).
of nonlethal weapons [4]. Potentially, this will also increase the occurrence of physical injuries that may be associated with these kinds of weapons, as previously described in several cases [5, 6]. Furthermore, as technology advances, new kinds of nonlethal weapons
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Address for Correspondence Misha D.P. Luyer, MD, PhD Department of Surgery Maasland Hospital Sittard PO Box 5500 6130 MB Sittard The Netherlands Phone (+31/46) 4597777 e-mail:
[email protected]
Eur J Trauma Emerg Surg 2009 Æ No. 5 Ó URBAN & VOGEL
