Schmelzle Moritz, Matthaei Hanno, Tustas Roy Y, Schmitt Marcus, Müller-Mattheis Volker, Linhart Wolfgang, Eisenberger Claus F, Knoefel Wolfram T, Esch Jan Schulte Am
Department of General Surgery, Heinrich-Heine-University Düsseldorf, Germany.
Cases J. 2008 Nov 13;1(1):307. doi: 10.1186/1757-1626-1-307.
There are numerous cases of abdominal injuries due to bullets. Abdominal injuries due to bullets are a diagnostic and therapeutic challenge. Here, an unusual case of an abdominal perforation caused by a metal projectile, lead to confusion in the interpretation of the preoperative computer tomography.
We present an unusual case of a 32-year-old male worker who sustained a "shot" to the left upper abdominal quadrant, as a result of a work-related accident. The projectile derived from a special wire that tore during operation. One chain element happened to accelerate towards the patients belly and perforated the abdominal wall. Computer tomography located the radiopaque projectile to the cortex of the left kidney and showed a lesion of the tail of the pancreas. The presence of intraperitoneal free air suggested a gastrointestinal perforation. Immediate open exploration of the peritoneal cavity and the retroperitoneal space revealed perforating lesions of the anterior and posterior gastric wall, as well as the pancreatic tail. The projectile was finally retrieved in the upper pole of the left kidney. The patient had a good clinical course subsequent to surgery and was discharged in good general condition.
This case represents a rare form of a retained bullet injury and corroborates the need of sufficient measures of worker-protection in area of diamond-studded wire cutting devices.
因子弹导致腹部损伤的病例众多。子弹所致腹部损伤在诊断和治疗方面具有挑战性。在此，一例由金属射弹导致的腹部穿孔的不寻常病例，致使术前计算机断层扫描的解读出现混淆。
我们呈现一例不寻常病例，一名32岁男性工人因工作相关事故左上腹象限遭受“枪击”。射弹源自操作过程中撕裂的特殊金属丝。一个链节碰巧朝着患者腹部加速并穿透腹壁。计算机断层扫描显示不透射线的射弹位于左肾皮质，并显示胰腺尾部有损伤。腹腔内游离气体提示存在胃肠道穿孔。立即对腹腔和腹膜后间隙进行开放探查，发现胃前壁和后壁以及胰腺尾部有穿孔性损伤。射弹最终在左肾上级被取出。患者术后临床过程良好，出院时全身状况良好。
该病例代表了一种罕见的留存子弹损伤形式，证实了在镶嵌金刚石的金属丝切割设备领域采取充分的工人保护措施的必要性。
