Park Chan Hee, Lee Jeong Woo
Division of Trauma Surgery, Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Korea.
J Trauma Inj. 2022 Aug;35(Suppl 1):S8-S14. doi: 10.20408/jti.2021.0085. Epub 2022 Jun 3.
Penetrating abdominal injuries are rare in countries that do not allow legal possession of firearms by the public. We report a case of a 27-year-old male patient with a penetrating liver injury caused by metal fragments released in a blast accident. On the day of the accident, there was a metal explosion, and multiple fragments of the metal lodged in the patient's abdomen. The metal fragments were widely distributed over the abdomen and limited to the subcutaneous layer. A computed tomography scan showed that one metal fragment had penetrated near the right upper quadrant. First, we tried exploratory laparoscopy to accurately locate and remove the presumed metal fragment under the liver, on the side of the gallbladder, and near the duodenum. However, we could not find the metal fragment and converted the procedure to open laparotomy. The metal fragment was found to be completely lodged in segment 4, the quadrate lobe to the left of the gallbladder. To remove the fragment, a 2-cm incision was made on the liver surface where the metal fragment was found. The patient's general postoperative condition was satisfactory, with no findings of bile leakage or bleeding. In conclusion, clinicians who do not have experience with these injuries can still provide adequate treatment by selecting a treatment method based on the patient's condition as well as the velocity of trauma. The laparoscopic approach, as a less invasive procedure, may be worthwhile for treating penetrating trauma. Additionally, laparoscopic exploratory laparotomy may be considered in selected cases.
在不允许公众合法持有枪支的国家，穿透性腹部损伤较为罕见。我们报告一例27岁男性患者，因爆炸事故释放的金属碎片导致穿透性肝损伤。事故当天发生了金属爆炸，多个金属碎片嵌入患者腹部。金属碎片广泛分布于腹部，局限于皮下层。计算机断层扫描显示一个金属碎片穿透右上腹附近。首先，我们尝试进行探查性腹腔镜检查，以准确定位并取出肝脏下方、胆囊一侧和十二指肠附近可能存在的金属碎片。然而，我们未能找到金属碎片，于是将手术改为开腹手术。发现金属碎片完全嵌顿在胆囊左侧的方叶（第4段）。为取出碎片，在发现金属碎片的肝脏表面做了一个2厘米的切口。患者术后总体情况良好，未发现胆漏或出血迹象。总之，对于这些损伤缺乏经验的临床医生，仍可根据患者病情以及创伤速度选择治疗方法，从而提供充分的治疗。腹腔镜手术作为一种侵入性较小的手术方式，对于治疗穿透性创伤可能是值得的。此外，在某些特定病例中可考虑采用腹腔镜探查性剖腹术。
