Flippin J Alford, Kishawi Sami, Braunstein Hannah, Lasinski Alaina M
Department of Surgery, Division of Trauma, Critical Care, Burns, and Acute Care Surgery, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109-1998, USA.
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Surg Case Rep. 2021 Jun 24;7(1):148. doi: 10.1186/s40792-021-01238-z.
Shotgun injuries are a relatively uncommon type of trauma, and therefore may present a challenge in management for trauma surgeons. This is particularly true in the case of surgeons unfamiliar with the unique characteristics of shotgun wounds and the mechanics of shotguns. In many cases, the shot pellets are the primary source of injury. However, a broad understanding of shotgun mechanics is important in recognizing alternative presentations. This article details a case of sabot (a stabilization device used with certain projectiles) retention after a close-range shotgun injury, reviews underlying shotgun mechanics, and discusses strategies for the detection and mitigation of these injuries. The aim of this case report is to increase awareness of and reduce the potential morbidity of close-range shotgun injuries.
A middle-aged female presented to the Emergency Department with wounds to her right hip and flank after suffering a shotgun injury. A contrast computed tomography scan demonstrated no evidence of hollow viscous or vascular injury, but was otherwise severely limited by scatter artifact from the numerous embedded pellets. The patient was admitted for wound care and discharged 2 days later with a clean wound bed and no evidence of tissue necrosis. Six days after injury, she reported an "unusual" smell associated with severe pain in her right hip wound. She was evaluated in clinic where examination revealed a retained foreign body, identified to be a shotgun shell sabot, which was removed in clinic. She presented again several days before scheduled follow-up with a persistent foul smell from her wound and was noted to have necrotic tissue at the base and margins of the wound that required hospital readmission for operative debridement and closure with negative pressure wound therapy. The patient had an uncomplicated recovery after surgical debridement.
Although shotgun sabot penetration and retention are rare, they are associated with significant morbidity. Sabot penetration should be considered if injury narrative, physical examination, or radiographic characteristics indicate a distance from shotgun to patient of less than 2 m. A high degree of suspicion is indicated at less than 1 m.
霰弹枪伤是一种相对不常见的创伤类型，因此可能给创伤外科医生的治疗带来挑战。对于不熟悉霰弹枪伤独特特征和霰弹枪原理的外科医生来说尤其如此。在许多情况下，霰弹丸是主要的致伤源。然而，全面了解霰弹枪原理对于识别其他表现形式很重要。本文详细介绍了一例近距离霰弹枪伤后弹托（与某些射弹一起使用的稳定装置）留存的病例，回顾了霰弹枪的基本原理，并讨论了检测和减轻这些损伤的策略。本病例报告的目的是提高对近距离霰弹枪伤的认识并降低其潜在发病率。
一名中年女性因霰弹枪伤后右髋部和侧腹受伤被送往急诊科。对比计算机断层扫描显示没有中空脏器或血管损伤的迹象，但因大量嵌入的弹丸产生的散射伪影而受到严重限制。患者入院接受伤口护理，两天后出院，伤口床清洁，无组织坏死迹象。受伤六天后，她报告右髋部伤口有“异常”气味并伴有剧痛。她在诊所接受评估，检查发现有一个留存的异物，经鉴定为霰弹枪的弹托，在诊所被取出。在预定随访前几天，她再次就诊，伤口持续有恶臭，发现伤口底部和边缘有坏死组织，需要再次入院进行手术清创并用负压伤口治疗进行缝合。患者在手术清创后恢复顺利。
虽然霰弹枪弹托穿透和留存很少见，但它们与严重的发病率相关。如果受伤经过、体格检查或影像学特征表明霰弹枪与患者的距离小于2米，则应考虑弹托穿透。距离小于1米时，高度怀疑有弹托穿透。
