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1.
J Med Case Rep ; 16(1): 198, 2022 May 22.
Artículo en Inglés | MEDLINE | ID: mdl-35598001

RESUMEN

BACKGROUND: Bullet embolus is a rare condition following gunshot injuries and represents a clinical challenge regarding both diagnosis and management. CASE PRESENTATION: We report the case of a 35-year-old Iranian (Middle-Eastern) male patient with a shotgun injury to both buttocks, which traveled to the heart and the popliteal area through the femoral vein and superficial femoral artery, respectively. Surgical intervention was applied for the popliteal pellet, and the patient was discharged without further complications. CONCLUSION: Although bullet emboli can be a clinical challenge, with the advent of modern procedures, removal has become safer. X-ray, computed tomography, and transthoracic and/or transesophageal echocardiography may be used as adjuncts to help establish the diagnosis.


Asunto(s)
Embolia , Migración de Cuerpo Extraño , Heridas por Arma de Fuego , Adulto , Embolia/diagnóstico por imagen , Embolia/etiología , Embolia/cirugía , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/cirugía , Migración de Cuerpo Extraño/complicaciones , Humanos , Irán , Masculino , Radiografía , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/diagnóstico por imagen , Heridas por Arma de Fuego/cirugía
2.
Spinal Cord Ser Cases ; 8(1): 45, 2022 Apr 26.
Artículo en Inglés | MEDLINE | ID: mdl-35474303

RESUMEN

INTRODUCTION: There exists sparse literature on Gunshot injuries (GSI) to the pediatric spine, its natural course, management protocols and outcomes following surgical intervention. Here, we present a projectile injury to the paediatric lumbar spine without any osseous disruption in a 5-year-old child requiring surgical management. CASE PRESENTATION: A 5-year-old child presented with a gunshot injury to the pediatric lumbar spine. On radiological imaging, there was no osseous disruption and an intraspinal canal projectile was embedded in an organised infected complex, compressing onto the left-sided L5 traversing nerve root with resultant grade 4 motor power of the left Extensor Hallucis Longus (EHL). Under fluoroscopic guidance using two separate mini-open incisions, the pellets were extracted. One from the spinal canal through left-sided L4 laminotomy and the other from the right paraspinal region. Post-surgical decompression and pellet retrieval there was gradual recovery to grade 5 motor power of Left EHL and improvement in the general condition of the child. CONCLUSION: The absence of osseous disruption can be attributed to the size of the projectile, widely spaced interlaminar spaces in the lumbar spine due to the absence of lumbar lordosis in the pediatric group and flexibility of the pediatric spine owing to its ligamentous laxity.


Asunto(s)
Radiculopatía , Heridas por Arma de Fuego , Niño , Preescolar , Descompresión Quirúrgica , Humanos , Laminectomía , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Radiculopatía/cirugía , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/diagnóstico por imagen , Heridas por Arma de Fuego/cirugía
3.
BMJ Case Rep ; 15(3)2022 Mar 08.
Artículo en Inglés | MEDLINE | ID: mdl-35260401

RESUMEN

Vascular injury is a common complication in firearm injuries; however, intravascular missile embolism is relatively rare. There are only 38 documented cases of intravascular missile embolisation to the heart. Bullet embolisms are difficult to diagnose even with multiple diagnostic modalities and even once identified, the most optimal choice of surgical management is debated. Our patient presented with a gunshot wound to the right posterior shoulder. Cardiac focused assessment with sonography for trauma, chest X-ray, CT and echocardiogram were performed, showing missile location adjacent to the right ventricle with inconclusive evidence of pericardial injury. Exploratory median sternotomy was performed, revealing intact pericardium and injury to the superior vena cava (SVC) with bullet embolisation to the right ventricle. The patient became temporarily asystolic secondary to haemorrhage from the SVC injury. Cardiac massage was performed, dislodging the missile into the inferior vena cava. A venotomy was performed to retrieve the bullet and vascular injuries were primarily repaired.


Asunto(s)
Embolia , Armas de Fuego , Migración de Cuerpo Extraño , Heridas por Arma de Fuego , Embolia/diagnóstico por imagen , Embolia/etiología , Embolia/cirugía , Migración de Cuerpo Extraño/cirugía , Humanos , Vena Cava Superior/diagnóstico por imagen , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/diagnóstico por imagen , Heridas por Arma de Fuego/cirugía
4.
J Med Case Rep ; 16(1): 73, 2022 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-35180884

RESUMEN

BACKGROUND: Splenosis is the heterotopic autotransplantation of splenic tissue after severe splenic trauma and/or splenectomy. The epidemiology is elusive, but splenosis is frequently misdiagnosed as malignant tumors of gastrointestinal, gynecological, or hematological origin before the correct diagnosis is ultimately found. We herein report a rare case of combined, extensive intraabdominal and intrathoracic splenosis initially presenting as pleural mesothelioma. CASE PRESENTATION: A 63-year-old Caucasian male presented with dyspnea and recurring thoracic pain. Initial X-ray and computed tomography scans showed disseminated intrathoracic and intraabdominal lesions. Consequently, thoracoabdominal mesothelioma or a polytopically metastasized cancer of unknown origin was suspected. A thorough examination of the patient's medical history and contrast-enhanced ultrasound by a skilled examiner revealed the diagnosis of extensive abdominal and thoracic splenosis as a consequence of an abdominal gunshot wound with a ruptured diaphragm several decades earlier. Timely diagnosis by noninvasive measures prevented the patient from potential complications of harmful diagnostic procedures, including nuclear imaging and biopsies. The patient is currently treated for hepatitis C and chronic obstructive lung disease, whereas no specific treatment for splenosis is required. CONCLUSIONS: We present a case of rare intrathoracic and intraperitoneal splenosis mimicking mesothelioma. Contrast-enhanced ultrasound and thorough patient history were used for diagnosis and prevented this patient from having to undergo potentially harmful diagnostics. Splenosis can occur after splenic trauma and, consequently, needs to be considered as a rare differential diagnosis to malignant tumors of various origins when a matching patient history is obtained.


Asunto(s)
Traumatismos Abdominales , Mesotelioma , Esplenosis , Heridas por Arma de Fuego , Traumatismos Abdominales/complicaciones , Diagnóstico Diferencial , Humanos , Masculino , Mesotelioma/complicaciones , Mesotelioma/diagnóstico por imagen , Persona de Mediana Edad , Esplenectomía , Esplenosis/diagnóstico por imagen , Esplenosis/etiología , Heridas por Arma de Fuego/complicaciones
6.
Am Surg ; 88(3): 538-541, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33380156

RESUMEN

Penetrating neck trauma comprises 5%-10% of all traumatic injuries in adults and carries up to a 10% mortality rate for those affected. Management of penetrating neck trauma can be challenging and often requires a multidisciplinary approach. A case of penetrating neck trauma via self-inflicted gunshot wound to zones 1-3 of the neck in an intoxicated, suicidal 60-year-old man is presented. Immediately after stabilization by the trauma surgery team, surgical reconstruction using a pectoralis major pedicled myocutaneous flap was completed by the plastic and reconstructive surgery team. The patient's hospital course was complicated by injury to the left phrenic nerve, oropharyngeal swallowing dysfunction, and left diaphragmatic dysfunction. The trauma team initiated prompt multidisciplinary responses to each of these complications as they arose by involving the plastic and reconstructive surgery, otolaryngology, gastroenterology, and speech language pathology teams. Early involvement of the physical medicine and rehabilitation, psychiatry, dietary, and pharmacy teams allowed for early optimization and monitoring of the patient's mobility, psychological, and nutritional statuses. The timely initiation of multidisciplinary care in this patient's case allowed for the patient to not only to survive a potentially fatal penetrating neck trauma, but to be discharged to a rehabilitation facility with an independent level of function. Given the complications due to severe penetrating neck trauma of zones 1-3 in this case, it is essential for early involvement of the appropriate subspecialty teams in order to achieve the best possible outcome for the patient.


Asunto(s)
Cervicoplastia/métodos , Traumatismos del Cuello/cirugía , Grupo de Atención al Paciente , Intento de Suicidio , Colgajos Quirúrgicos/trasplante , Heridas por Arma de Fuego/cirugía , Trastornos de Deglución/cirugía , Humanos , Masculino , Ilustración Médica , Persona de Mediana Edad , Traumatismos del Cuello/diagnóstico por imagen , Traumatismos del Cuello/etiología , Grupo de Atención al Paciente/organización & administración , Músculos Pectorales/trasplante , Fotograbar , Nervio Frénico/lesiones , Parálisis Respiratoria/cirugía , Tomografía Computarizada por Rayos X , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/diagnóstico por imagen
7.
Ann Vasc Surg ; 79: 443.e1-443.e3, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-34656715

RESUMEN

Abdominal trauma leads rarely to severe renal injury such as acquired arterioveinous fistula. Here, we present the case of a 46-year-old man with a history of suicide attempt by a gunshot in the abdomen. At that time, explorative laparotomy was unremarkable. He consulted 23 years later for chronic left lumbar pain and was diagnosed with an arterioveinous fistula of left renal vessels with a-10-cm aneurysm of the left renal artery. We performed a left nephrectomy and endovascular clamping was the best option to manage this giant aneurysm in a hostile abdomen.


Asunto(s)
Traumatismos Abdominales/etiología , Aneurisma/etiología , Fístula Arteriovenosa/etiología , Arteria Renal/lesiones , Venas Renales/lesiones , Lesiones del Sistema Vascular/etiología , Heridas por Arma de Fuego/complicaciones , Traumatismos Abdominales/diagnóstico por imagen , Traumatismos Abdominales/cirugía , Aneurisma/diagnóstico por imagen , Aneurisma/cirugía , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/cirugía , Enfermedades Asintomáticas , Constricción , Procedimientos Endovasculares , Humanos , Masculino , Persona de Mediana Edad , Nefrectomía , Arteria Renal/diagnóstico por imagen , Arteria Renal/cirugía , Venas Renales/diagnóstico por imagen , Venas Renales/cirugía , Intento de Suicidio , Factores de Tiempo , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/cirugía
8.
Am Surg ; 88(4): 793-795, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-34727708

RESUMEN

Renoduodenal fistula is an uncommon occurrence and usually results as a complication of injury or inflammatory process. Here, we describe a case of renoduodenal fistula formation after traumatic injury via gunshot wound to the abdomen. The patient suffered right renal and ureteral injury, complicated by urine leak, managed by surgery, interventional radiology, and urology. His post-hospital course was complicated by recurrent urinary tract infections and was found to have a renoduodenal fistula 3 months after the initial operation. Patient underwent uncomplicated right nephrectomy and repair of fistula. Etiology, presentation, diagnosis, and treatment options of renoduodenal fistula are discussed.


Asunto(s)
Traumatismos Abdominales , Fístula , Heridas por Arma de Fuego , Abdomen , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/diagnóstico , Traumatismos Abdominales/cirugía , Fístula/complicaciones , Humanos , Nefrectomía , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/cirugía
10.
Am J Surg ; 223(4): 787-791, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-34144806

RESUMEN

BACKGROUND: Nationally, 115,000 non-fatal firearm injuries occurred in 2017, with many such victims possessing retained bullet fragments (RBFs); however, the impact of RBFs has not been well studied. METHODS: An institutional trauma database from an urban, level one trauma center was queried for patients presenting with gunshot wounds (GSWs) to the ED in 2017. GSWs were stratified by the presence or absence of RBFs. Groups were compared using t-tests, chi-squared, and logistic regression. RESULTS: Of 674 patients with GSWs who met inclusion criteria, 394 had RBFs versus 280 with no RBFs. Patients with RBFs were more likely admitted from the ED (57.4% vs. 41.8%, p < 0.001), had significantly higher rates of return to the ED within six months (30.7% vs. 18.6%, p < 0.001), and higher rates of subsequent GSW in the next year (5.1% vs. 1.8%, p = 0.03). On return to ED, 17.6% of those with a RBF had symptoms associated with their RBF. CONCLUSION: RBFs may represent an unrecognized risk factor for both repeat ED visits and subsequent bullet injury.


Asunto(s)
Armas de Fuego , Heridas por Arma de Fuego , Humanos , Estudios Retrospectivos , Factores de Riesgo , Centros Traumatológicos , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/epidemiología , Heridas por Arma de Fuego/cirugía
11.
Eur J Trauma Emerg Surg ; 48(2): 881-889, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32889613

RESUMEN

BACKGROUND: Global trend has seen management shift towards selective conservatism in penetrating abdominal trauma (PAT). The purpose of this study is to compare the presentation; management; and outcomes of patients with PAT managed operatively versus non-operatively. METHODS: Prospective cohort study of all patients Ùpresenting with PAT to Groote Schuur Hospital, Cape Town from 01 May 2015 to 30 April 2017. Presentation; management; and outcomes of patients were compared. Univariate predictors of delayed operative management (DOM) were explored. RESULTS: Over the 2-year study period, 805 patients with PAT were managed. There were 502 (62.4%); and 303 (37.6%) patients with gunshot (GSW) and stab wounds (SW), respectively. The majority were young men (94.7%), with a mean age of 28.3 years (95% CI 27.7-28.9) and median ISS of 13 (IQR 9-22). Successful non-operative management was achieved in 304 (37.7%) patients, and 501 (62.5%) were managed operatively. Of the operative cases, 477 (59.3%) underwent immediate laparotomy and 24 (3.0%) DOM. On univariate analysis, number; location; and mechanism of injuries were not associated with DOM. Rates of therapeutic laparotomy were achieved in 90.3% in the immediate, and 80.3% in the DOM cohorts. The mortality rate was 1.3, 11.3 and 0% in the in the NOM, immediate laparotomy and DOM subgroups, respectively. The rate of complications was no different in the immediate and DOM cohorts (p > 0.05). CONCLUSION: Patients with PAT in the absence of haemodynamic instability; peritonism; organ evisceration; positive radiological findings, or an unreliable clinical examination, can be managed expectantly without increased morbidity or mortality.


Asunto(s)
Traumatismos Abdominales , Heridas por Arma de Fuego , Heridas Penetrantes , Heridas Punzantes , 2,5-Dimetoxi-4-Metilanfetamina , Traumatismos Abdominales/epidemiología , Traumatismos Abdominales/cirugía , Adulto , Humanos , Laparotomía , Masculino , Estudios Prospectivos , Estudios Retrospectivos , Sudáfrica/epidemiología , Centros Traumatológicos , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/epidemiología , Heridas por Arma de Fuego/terapia , Heridas Penetrantes/epidemiología , Heridas Penetrantes/cirugía , Heridas Punzantes/epidemiología , Heridas Punzantes/cirugía
12.
Am Surg ; 88(5): 1014-1015, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-34964692

RESUMEN

We describe the management of bullet embolism from a penetrating cardiac injury, including the clinical, radiographic, and operative considerations in this challenging trauma scenario. Bullet embolism represents a rare but complex subset of ballistic penetrating trauma, and highlights the importance of radiographic correlation with intraoperative findings.


Asunto(s)
Embolia/etiología , Lesiones Cardíacas/complicaciones , Arteria Ilíaca , Heridas por Arma de Fuego/complicaciones , Aorta Abdominal , Embolia/diagnóstico por imagen , Embolia/cirugía , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/etiología , Lesiones Cardíacas/cirugía , Humanos , Arteria Ilíaca/diagnóstico por imagen , Heridas por Arma de Fuego/diagnóstico por imagen , Heridas por Arma de Fuego/cirugía
14.
Ulus Travma Acil Cerrahi Derg ; 27(6): 702-705, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34710219

RESUMEN

Emergency physicians may overlook spinal cord injury in patients when the direct impact of a gunshot on the spine is lacking. A 30-year-old man who was shot on his right chest wall was brought to the emergency department. He arrived in a state of shock and underwent emergent thoracotomy for massive hemothorax. After surgery, he was found to be paraplegic. Magnetic resonance imaging of the spine showed T4 spinal cord contusion. The penetrating bullet dissipates energy to the surrounding tissue and contuses the spinal cord. Another assumption of the spinal cord injury is the impairment of blood supply to the cord. No effective treatment exists for gunshot-related indirect injury to the spinal cord. These reported cases reminded emergency physicians that after stabilization of the patient with a gunshot wound, a complete neurologic examination should be performed to discover occult spinal cord injury.


Asunto(s)
Contusiones , Traumatismos de la Médula Espinal , Heridas por Arma de Fuego , Adulto , Humanos , Masculino , Paraplejía/etiología , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/cirugía , Resultado del Tratamiento , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/cirugía
18.
Ann R Coll Surg Engl ; 103(8): e244-e248, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34464576

RESUMEN

Penetrating injuries to the subclavian artery carry a high mortality rate, especially when the patient presents in shock. Rapid and effective haemorrhage control is challenging due to the anatomical location at the thoracic outlet. Historically, vessel ligation has been used to control bleeding, but this is often performed late, when metabolic exhaustion is established, and is associated with upper-limb ischaemia and limb loss. Rapid proximal control through the chest with temporary intravascular shunting is the damage control technique of choice to temporise blood loss and restore perfusion until the patient is physiologically optimised for a delayed definitive vascular repair. We describe a case of vascular damage control in a patient after gunshot wound.


Asunto(s)
Arteria Subclavia/cirugía , Vena Subclavia/cirugía , Heridas por Arma de Fuego/complicaciones , Humanos , Masculino , Vena Safena/trasplante , Arteria Subclavia/lesiones , Vena Subclavia/lesiones , Heridas por Arma de Fuego/cirugía , Adulto Joven
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