ABSTRACT
Introduction: Penetrating ballistic cardiac injury is usuallyfatal before victim the gets any medical help. Retained intracardiac missile is a very rare entity and so far a very few caseshave been reported in the literature.Case report: We describe a young patient who presentedwith multiple life threatening pellet injuries involving chest,abdomen, and limbs. Patient had CT and echocardiographydocumented retained pellets in the heart with pericardialeffusion. Patient was managed successfully using conservativeapproach without any surgical intervention.Conclusion: this case highlights the importance of carefulmonitoring and conservative approach in such critically illpatients for a better outcome.
ABSTRACT
Background: Penetrating cardiac injuries are rare and considered the most lethal of all trauma patients. Managing cardiac injuries is a great challenge for the trauma surgeons and the outcome of the treatment of such critical condition depends on the mechanism of injury, haemodynamic status of the patients at the time of presentation, heart chamber involved and other associated injuries. Materials and Methods: This is a prospective observational study of consecutive six patients with penetrating cardiac injuries from January 2015 to December 2019 treated in Regional Institute of Medical Sciences, Imphal, India. eFAST and CT scan of the chest were the main imaging methods used for diagnosis. All patients underwent tube thoracostomy for associated haemothorax in the emergency ward. Results: All the patients had penetrating cardiac injuries due to stabbing. Five (63.3%) patients presented with features of cardiac tamponade or with severe hypotension (systolic BP less than 80 mmHg) and one (16.7%) patient who was haemodynamically stable at the time of presentation had developed features of cardiac tamponade after 24 hours. Four patients had undergone emergency left anterolateral thoracotomy, one patient had undergone median sternotomy, and one patient underwent left anterolateral thoracotomy on the second day after admission. Conclusion: A high index of suspicion for cardiac trauma is extremely important in patients presented with penetrating thoracic injuries or upper abdominal injuries. Computed tomography of the chest can show the haemopericardium giving detailed information of associated pulmonary injury and hemothorax. Prompt diagnosis and early surgical intervention play a vital role to save these critically injured patients.
ABSTRACT
A 24-year-old woman, under the treatment for atypical depression, visited our emergency room on foot with a chief complaint that she stabbed herself in the chest with a sewing needle. Chest X-ray and plain CT showed the needle penetrating the chest into the heart. There was no sign of pneumothorax or cardiac tamponade. She was hemodynamically stable. Echocardiography revealed atrial septal defect (ASD) by chance. We performed urgent surgery for needle removal and ASD closure through median sternotomy. The needle was easily recognized near the right ventricle apex. The right atrium was opened, but the needle was not seen through the tricuspid valve because of trabecular formation. After the needle was removed, ASD was closed using the direct suture method. The needle was 35 mm long. She was transferred to the psychiatry department on postoperative day 4 and had a good postoperative course.
ABSTRACT
A 22-year-old man shot himself with a nail gun. He was admitted to a local hospital with chest pain. Chest x-ray film and chest computed tomography showed 5 nails penetrating the left thorax and some of these nails were considered to reach the pericardium. He was transferred to our hospital for intervention. Left thoracotomy was performed. Three nails reached the left ventricle and one nail was embedded the left lung. The last nail was found by transesophageal echocardiography to be completely buried in the left ventricle wall. All nails were removed and the left ventricular wounds were repaired with felt 4-0 surgipro mattress sutures. He made an uneventful postoperative recovery with a normal postoperative echocardiography and he was discharged on postoperative day 12 in good condition.