Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 6 , ISSUE 3 ( September-December, 2017 ) > List of Articles

CASE REPORT

Survival after penetrating Shrapnel to the Heart and Colon: Which Injuries to tackle First?

M Ezzedien Rabie, Ricardo Gallo, Medhat A Refaie, Mansour Al Asmary

Citation Information : Rabie ME, Gallo R, Refaie MA, Asmary MA. Survival after penetrating Shrapnel to the Heart and Colon: Which Injuries to tackle First?. Panam J Trauma Crit Care Emerg Surg 2017; 6 (3):209-213.

DOI: 10.5005/jp-journals-10030-1193

License: CC BY 3.0

Published Online: 01-12-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim

To report on the clinical course of a patient who received penetrating shrapnel to the heart and colon.

Background

Penetrating missiles to the heart is a highly lethal incident, particularly, when associated with other serious injuries.

Case report

This is the case of a 29-year-old male soldier, who sustained multiple shrapnel injuries caused by an explosive device in the war zone. Shrapnel penetrated the cecum and another lodged in the interventricular septum of the heart. Surprisingly, the patient was stable enough to undergo a staged procedure, where he was subjected to limited right hemicolectomy first, followed by open heart surgery to extract the cardiac shrapnel twelve hours later. His convalescence was uneventful and was discharged in a good condition.

Conclusion

With timely intervention and close collaboration between the concerned clinicians in specialized centers, patients with penetrating shrapnel to vital structures, including the heart, could have a successful outcome.

Clinical significance

Critical thinking is needed to prioritize which injuries to deal with first, in patients with near lethal injuries.

How to cite this article

Rabie ME, Gallo R, Refaie MA, Asmary MA. Survival after penetrating Shrapnel to the Heart and Colon: Which Injuries to tackle First? Panam J Trauma Crit Care Emerg Surg 2017;6(3):209-213.

Objetivo

Reportar el curso clínico de un paciente que recibió esquirlas penetrantes al corazón y colon.

Historia

Misiles penetrantes en el corazón es un incidente altamente letal, especialmente cuando se asocia con otras lesiones serias.

Descripción del caso

un soldado masculino de 29 años de edad, que sufrió múltiples heridas de esquirlas causadas por un artefacto explosivo en la zona de guerra. Una de las esquirlas penetró el intestino ciego y otra alojada en el septo interventricular del corazón. Sorprendentemente, el paciente estaba lo suficientemente estable como para someterse a un procedimiento de etapas, donde fue sometido a hemicolectomía derecha limitada en primer lugar, seguido por cirugía a corazón abierto para extraer la esquirla cardiaca doce horas más tarde. Su convalecencia fue sin incidentes y fue dado de alta en buenas condiciones.

Conclusión

Con la intervención oportuna, y estrecha colaboración entre los médicos tratantes, en centros especializados, pacientes con esquirlas penetrantes a estructuras vitales, incluyendo el corazón, puden tener un resultado exitoso.

Significado clínico

Con pensamiento crítico, es necesario priorizar qué lesiones tratar primero, en pacientes con lesiones letales.


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