Gunshot exit wound and telling it from the entry

What it is

The exit wound is where the projectile leaves the body. Because the projectile leaves deformed, tumbling or carrying tissue, the exit is usually larger, irregular or stellate, with everted edges, and lacks the abrasion ring, the bullet wipe and discharge residues. There is not always an exit: the projectile may stay in the body. And the rule "larger = exit" often fails: shored exits, contact shots (stellate entries) and projectiles that passed through an object before entering can reverse the pattern.

How to tell it apart

• The decision rests on everything together: edges, rings, residues, bone bevelling, track and clothing, not a single feature.
• Clothing helps: fibres turn inwards at the entry and outwards at the exit, and residues stay on the fabric.
• Imaging (X-ray, CT) shows the track, fragments and retained projectiles.
• With no exit, the projectile is still in the body: recovering it is key evidence.

How to recognise it

• An irregular, slit-like, stellate or round hole with everted edges.
• No abrasion ring, no bullet wipe, no soot and no stippling.
• Tissue, fat or bone fragments may protrude.
• On the skull: bevelling of the outer table.

How it forms

• The projectile pushes the skin from inside and breaks it outwards.
• If it deforms, tumbles or carries bone, the exit becomes larger and irregular.
• If the skin is pressed against a firm surface, it is squeezed against it and abraded.

Step by step

1. Describe each wound separately and number them.
2. Record size, shape, edges, rings and residues for each.
3. Link wounds to the track from surgery or imaging.
4. Examine the clothing at each wound.
5. Call a wound entry or exit only on the whole set of findings.

Next step: what to do and document

• In the emergency room, prefer "wound 1, wound 2" with a description over "entry" and "exit" if you are unsure.
• Order imaging to locate retained projectiles and fragments.
• Keep removed projectiles and clothing with chain of custody (see chain of custody).
• Note that the skin alone may not be enough if there was thick clothing, an intermediate target or a supporting surface, and record those circumstances.
• Start the reporting pathway and notify as the current rules require.

Common mistakes

• Calling the larger wound the exit without further analysis.
• Forgetting that a shored exit can have an abraded rim.
• Not looking for the projectile when there is no exit.
• Discarding the clothing, which keeps inverted or everted fibres and residues.

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Elsewhere in DurgiPedia

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Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority.

Sources: Gunshot Wound Patterns: A Narrative Review From a Forensic Medical Perspective (Cureus (PMC), 2026); Heridas atípicas producidas por proyectil de arma de fuego: reporte de caso (Revista Medicina Legal de Costa Rica (SciELO), 2022); Evidence of D-shaped wounds in the intrasomatic bullet path: two case reports (Forensic Science, Medicine and Pathology (PMC), 2023); Keyhole lesion caused by a fatal self inflicted headshot with a modified flare gun (Forensic Science, Medicine and Pathology (PMC), 2026).

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