Setiawan Eko, Shofwan Said, Anwar Sumadi Lukman, Ovaditya Shafira Zahra, Rizaldy Rheza, Janitra Grady
Department of Surgery, Medical Faculty, Sultan Agung Islamic University / Sultan Agung Islamic Hospital, Semarang, 50164, Indonesia.
Department of Anesthesiology, Medical Faculty, Sultan Agung Islamic University / Sultan Agung Islamic Hospital, Semarang, 50164, Indonesia.
Int J Surg Case Rep. 2021 Apr;81:105730. doi: 10.1016/j.ijscr.2021.105730. Epub 2021 Mar 5.
Surgical exploration of retained air rifle bullet at the neck region is challenging because it is difficult to find bullets during exploration and prevent damage to vital structures. A bedside real-time imaging technique is needed to determine the retained bullet's location to the surrounding structures and guiding exploration.
A 19-year-old male patient was admitted to the emergency department with neck pain after being shot by an air rifle. The patient's vital signs were stable. A small entry wound to the right lateral side of the neck without exit wound was found without neurological symptoms. The cervical X-ray showed the bullet at the third cervical vertebrae level. Surgical exploration was performed with needle-guiding ultrasonography. The bullet is a one-centimeter anterior transverse process of the third cervical vertebra marked by a hyperechoic object. Exploration was done by tracing the needle. Postoperative neurological evaluation was conducted, and no abnormalities were found.
Preoperative imaging modalities are crucial before the surgical exploration of a retained air rifle bullet. X-ray and CT-scan are imaging modalities that are often used as an initial assessment of retained foreign bodies. However, ultrasonography provides advantages over X-ray and CT scan to provide real-time imaging that supports the surgeon while performing surgical exploration. Ultrasonography with needle guiding exploration increases the precise location of a retained air rifle bullet.
Ultrasonography was a simple and precise real-time imaging modality for identifying and guiding the exploration of a retained air rifle bullet in the neck area.
对颈部存留的气步枪子弹进行手术探查具有挑战性，因为在探查过程中很难找到子弹，且要防止损伤重要结构。需要一种床边实时成像技术来确定存留子弹相对于周围结构的位置并指导探查。
一名19岁男性患者因被气步枪射中后颈部疼痛入住急诊科。患者生命体征稳定。在颈部右侧发现一个小的入口伤口，无出口伤口，且无神经症状。颈椎X线显示子弹位于第三颈椎水平。采用针引导超声进行手术探查。子弹位于第三颈椎前横突一厘米处，表现为一个高回声物体。通过追踪针进行探查。术后进行了神经学评估，未发现异常。
在对存留的气步枪子弹进行手术探查之前，术前成像方式至关重要。X线和CT扫描是常用的作为对存留异物初步评估的成像方式。然而，超声检查相对于X线和CT扫描具有优势，它能提供实时成像，在手术探查过程中为外科医生提供支持。针引导探查超声检查提高了存留气步枪子弹定位的精确性。
超声检查是一种简单而精确的实时成像方式，用于识别和指导颈部存留气步枪子弹的探查。
