Retained bullets: to remove or not to remove? Lessons from two clinical scenarios with intracardiac bullet embolization.

Autor: Hinton JB; Northeast Ohio Medical University, College of Medicine, 4209 St., OH-44, Rootstown, OH 44272, United States., Landwehr HJ; Northeast Ohio Medical University, College of Medicine, 4209 St., OH-44, Rootstown, OH 44272, United States., Loudon AM; Northeast Ohio Medical University, College of Medicine, 4209 St., OH-44, Rootstown, OH 44272, United States.; Department of Surgery, University Hospitals, 11100 Euclid Ave., Cleveland, OH 44106, United States.; Case Western Reserve University, 9501 Euclid Ave., Cleveland, OH 44106, United States., Moorman ML; Northeast Ohio Medical University, College of Medicine, 4209 St., OH-44, Rootstown, OH 44272, United States.; Department of Surgery, University Hospitals, 11100 Euclid Ave., Cleveland, OH 44106, United States.; Case Western Reserve University, 9501 Euclid Ave., Cleveland, OH 44106, United States.
Jazyk: angličtina
Zdroj: Journal of surgical case reports [J Surg Case Rep] 2024 Sep 18; Vol. 2024 (9), pp. rjae584. Date of Electronic Publication: 2024 Sep 18 (Print Publication: 2024).
DOI: 10.1093/jscr/rjae584
Abstrakt: Firearm-related injuries in the USA are increasing, with over 105,000 cases annually. Gunshot wounds (GSWs), especially those involving retained bullets, present complex challenges due to bullet trajectories and embolization risks. This study reviews two cases of bullet emboli, focusing on bullet localization strategies and timing of removal. Imaging techniques such as chest X-ray, CT scan, intraoperative fluoroscopy, and transesophageal echocardiogram were employed for localization. In Case 1, a stable patient with a left-back GSW had a bullet embolism from the inferior vena cava to the right ventricle, necessitating prompt removal. In Case 2, an unstable patient with thoracoabdominal GSWs experienced a delayed embolism to the aortic root, requiring multiple surgeries. Effective management of retained bullets involves diverse imaging and timely surgical intervention, especially for stable patients, emphasizing individualized and proactive strategies to enhance outcomes in bullet embolization cases.
Competing Interests: None declared.
(Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2024.)
Databáze: MEDLINE
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