Shannon F L, McCroskey B L, Moore E E, Moore F A
Department of Surgery, Denver General Hospital, CO 80204.
J Trauma. 1987 Oct;27(10):1118-22.
Venous missile embolism is a rare complication of penetrating trauma which poses controversial management options. We report a case of hepatic vein bullet embolism treated by percutaneous transvenous basket relocation and extraction via femoral vein cutdown. A review of 102 reported bullet emboli since 1930 indicates that the morbidity of a retained projectile is substantial (25%), while removal using modern techniques has few complications. Salient features of early extraction include: 1) prevention of proximal migration, 2) transvenous relocation of the missile to an accessible vein, and 3) peripheral surgical removal. Delayed recognition of an asymptomatic bullet embolus demands further judgment in guiding selective operative removal. A management scheme based on time of recognition, patient status, and embolus characteristics is presented for this unusual problem.
静脉内子弹栓塞是穿透性创伤的一种罕见并发症，其处理方式存在争议。我们报告一例经皮经静脉网篮复位并通过股静脉切开取出术治疗的肝静脉子弹栓塞病例。对1930年以来报道的102例子弹栓子的回顾表明，残留弹丸的发病率相当高（25%），而采用现代技术取出很少有并发症。早期取出的显著特点包括：1）防止近端移位；2）将子弹经静脉复位至可及静脉；3）经外周手术取出。对于无症状子弹栓子的延迟识别，在指导选择性手术取出时需要进一步判断。针对这个不寻常的问题，提出了一种基于识别时间、患者状况和栓子特征的处理方案。
