Jaramillo Paula M, Montoya Jaime A, Mejia David A, Pereira Warr Salin
Pablo Tobón Uribe Hospital, Department of Surgery, University of Antioquia, Medellin, Colombia.
Gastrointestinal Surgery and Digestive Endoscopy, National Cancer Institute, Militar Nueva Granada University, Bogotá, Colombia.
Case Rep Surg. 2018 Jan 24;2018:7839465. doi: 10.1155/2018/7839465. eCollection 2018.
Surgery for cardiac trauma is considered fatal and for wounds of the colon by associated sepsis is normally considered; however, conservative management of many traumatic lesions of different injured organs has progressed over the years.
A 65-year-old male patient presented with multiple shotgun wounds on the left upper limb, thorax, and abdomen. On evaluation, he was hemodynamically stable with normal sinus rhythm and normal blood pressure, no dyspnea, or abdominal pain. Computed tomography (CT) scan of the chest shows hematoma around the aorta without injury to the blood vessel wall with an intramyocardial projectile without pericardial effusion. CT scan of the abdomen showed pellets in the transverse colon and descending colon endoluminal without extravasation of contrast medium or intra-abdominal fluid. The patient remains hemodynamically stable, and nonsurgical procedure was established.
Patients with asymptomatic intramyocardial projectiles can be safely managed without surgery. Nonsurgical management is only possible in asymptomatic patients with trauma of the colon through close surveillance and with very selective patients since standard management is surgery.
Nonsurgical management of cardiac trauma, as well as colon penetrating trauma, can be performed in carefully selected patients with proper clinical follow-up, imaging, and laboratory studies.
心脏创伤手术被认为是致命的，结肠创伤通常因伴有败血症而被考虑手术；然而，多年来不同受伤器官的许多创伤性损伤的保守治疗已经取得了进展。
一名65岁男性患者，左上臂、胸部和腹部有多处猎枪伤。经评估，他血流动力学稳定，窦性心律正常，血压正常，无呼吸困难或腹痛。胸部计算机断层扫描（CT）显示主动脉周围有血肿，血管壁未受损，心肌内有弹丸，无心包积液。腹部CT扫描显示横结肠和降结肠腔内有弹丸，无造影剂外渗或腹腔内积液。患者血流动力学仍稳定，遂采取非手术治疗。
无症状心肌内弹丸患者可安全地不进行手术治疗。对于结肠创伤无症状患者，非手术治疗仅在密切监测且选择非常严格的患者中可行，因为标准治疗是手术。
经过精心挑选的患者，通过适当的临床随访、影像学和实验室检查，可以对心脏创伤以及结肠穿透伤进行非手术治疗。
