Abstract
Shotgun injuries provide a unique challenge to both forensic pathology and acute clinical care due to their complex internal ballistic behaviour and variable injury patterns. This report describes a case of a 33-year-old man who initially presented with apparent haemodynamic compensation following a mid-range abdominal shotgun injury; subsequently, he developed rapid respiratory deterioration and died. Post-mortem examination revealed a massive left-sided haemothorax caused not by direct thoracic injury, but by trans-diaphragmatic migration of blood from the abdominal cavity through multiple perforations of the left hemidiaphragm. This case highlights the forensic and clinical importance of the thoraco-abdominal transitional region, illustrating how seemingly localised abdominal trauma may cause fatal thoracic compromise. It further emphasises the potential for delayed and unexpected deterioration, as well as the medico-legal implications in interpreting such cases.
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