Gunshot injury to the left side of the neck with the lodged bullet in the carotid sheath: A case report.

RATIONALE

Penetrating neck trauma involving the carotid artery is rare but highly lethal, requiring prompt and accurate diagnosis followed by immediate surgical intervention.

PATIENT CONCERNS

A 20-year-old male presented with a high-velocity gunshot wound to the left side of the neck. Despite the severity of the injury, the patient was asymptomatic and hemodynamically stable.

DIAGNOSE

Initial evaluation, including ultrasound imaging, revealed a bullet lodged within the left common carotid artery.

INTERVENTIONS

Due to the high risk of vascular complications, the patient underwent emergency surgery. The damaged artery segment was resected, and a primary end-to-end anastomosis was performed.

OUTCOMES

The patient recovered well and was discharged without neurological deficits.

LESSONS

Early diagnosis and intervention are crucial in carotid artery injuries. This case demonstrates the limitations of computed tomography angiography in the presence of metallic artifacts and highlights the effectiveness of ultrasound for accurate diagnosis. Although penetrating neck injury management protocols typically recommend conservative management for asymptomatic Zone 2 injuries, surgical intervention is necessary due to the high-risk features of similar cases when the foreign object remains inside, and there is a risk of movement and severe damage. Adaptation of protocols based on individual injury characteristics can enhance patient outcomes. Although this is a rare case, similar cases have been reported, and it highlights the need to update the penetrating neck injury management protocols for the management of similar cases.