In a gunshot wound to the abdomen, which organ is least likely to be injured?

• A. Pancreas
• B. Large bowel
• C. Spleen
• D. Liver

Answer: (A)

The main idea is that penetrating wounds to the abdomen tend to injure organs that are in front and within the peritoneal cavity, where bullets travel most easily. The pancreas sits deep in the upper abdomen, behind the stomach and behind the peritoneum (retroperitoneal). Because of this guarded position, a bullet would have to pass through several structures to reach it, making pancreatic injury much less likely than injuries to other abdominal organs.

The liver, located in the right upper quadrant, is large and highly vascular, so it’s a common target. The spleen sits in the left upper quadrant and is also highly vulnerable due to its exposed location and blood supply. Large bowel loops are spread throughout the abdomen and are frequently encountered in penetrating trauma. In contrast, the pancreas is tucked away, so it tends to be spared in many gunshot wounds to the abdomen. If injured, pancreatic damage often shows up with delayed symptoms, adding to its relative rarity.