Work

Retained bullets: to remove or not to remove? Lessons from two clinical scenarios with intracardiac bullet embolization

Year: 2024

Type: article

Abstract: Firearm-related injuries in the USA are increasing, with over 105,000 cases annually. Gunshot wounds (GSWs), especially those involving retained bullets, present complex challenges due to bullet trajectories and embolization risks. This study reviews two cases of bullet emboli, focusing on bullet localization strategies and timing of removal. Imaging techniques such as chest X-ray, CT scan, intraoperative fluoroscopy, and transesophageal echocardiogram were employed for localization. In Case 1, a stable patient with a left-back GSW had a bullet embolism from the inferior vena cava to the right ventricle, necessitating prompt removal. In Case 2, an unstable patient with thoracoabdominal GSWs experienced a delayed embolism to the aortic root, requiring multiple surgeries. Effective management of retained bullets involves diverse imaging and timely surgical intervention, especially for stable patients, emphasizing individualized and proactive strategies to enhance outcomes in bullet embolization cases.

Source: Journal of Surgical Case Reports

DOI: 10.1093/jscr/rjae584

Authors: Jared B Hinton, Hunter J Landwehr, Andrew M Loudon, Matthew L Moorman

Institutions: Northeast Ohio Medical University, University Hospitals of Cleveland, University Hospitals Cleveland Medical Center, Case Western Reserve University

Language: English

Topic: Trauma Management and Diagnosis

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,050