RESUMO
Nowadays, gunshot injuries have become a common medical-legal issue because of easy accessibility of firearms. Gunshot injuries of head and neck region are highly morbid and fatal, particularly when they affect vital organs. In rare cases, atypical tract lines resulting from such injuries can cause difficulties in the diagnosis and treatment. In this report, a high energy gunshot injury involving head and neck region with an atypical bullet trajectory is presented. A 24-year male soldier was brought to the emergency department on account of gunshot injury following a conflict. Although the entrance and exit holes of bullets were confined to head and neck region, the whole body computed tomography scan was carried out in spite of his borderline hemodynamics. Whole body computed tomography revealed massive hemopneumothorax, mediastinal shift, hepatic laceration, and foreign body (bullet) in the liver. The patient was operated successfully by a multidisciplinary surgical team on emergency basis. This report highlights the necessity and importance of whole body computed tomography scan in such cases.
Assuntos
Traumatismos Craniocerebrais/diagnóstico , Corpos Estranhos/diagnóstico , Cabeça/diagnóstico por imagem , Lesões do Pescoço/diagnóstico , Pescoço/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Imagem Corporal Total/métodos , Ferimentos por Arma de Fogo/diagnóstico por imagem , Traumatismos Craniocerebrais/cirurgia , Serviços Médicos de Emergência , Armas de Fogo , Corpos Estranhos/terapia , Humanos , Laparotomia , Masculino , Lesões do Pescoço/cirurgia , Resultado do Tratamento , Ferimentos por Arma de Fogo/cirurgia , Adulto JovemRESUMO
Introduction. Digital ischemia is a rare complication of several chemotherapeutic medications. We aimed to present a patient with digital ischemia, secondary to a new generation chemotherapeutic drug, oxaliplatin. Case Report. 62-year-old woman presented to our department with severe pain, paresthesia, and distal acrocyanosis on her right hand fingertips. Her complaints started five days after the third cycle of a chemotherapy protocol consisting of 5-fluorourasil (5-FU), folinic acid, and oxaliplatin due to advanced colon carcinoma. On physical examination, hemorrhagic and partly ulcerative lesions were detected at her right hand fingertips. Radial and ulnar pulses were absent at affected side. Digital subtraction angiography revealed severe vascular resistance in the affected extremity. Iloprost trometamol treatment was started with the dosage of 1 ng/kg/min. In addition, low-molecule-weight heparin was used for preventing possible microemboli. Symptomatic relief was provided after five days, and patient was discharged on 7th day of treatment. Discussion. The pathogenesis of oxaliplatin induced vascular toxicity remains unclear. Endothelial damage, increased adherence of platelets, deposition of immune complexes as an immunologic effect of oxaliplatin, and hypercoagulable state may be the reason for arterial thrombosis, digital microemboli, possible digital ischemia, and their several consequences.
