Abstract
IntroductionThere are numerous cases of abdominal injuries due to bullets. Abdominal injuries due to bullets are a diagnostic and therapeutic challenge. Here, an unusual case of an abdominal perforation caused by a metal projectile, lead to confusion in the interpretation of the preoperative computer tomography.Case presentationWe present an unusual case of a 32-year-old male worker who sustained a "shot" to the left upper abdominal quadrant, as a result of a work-related accident. The projectile derived from a special wire that tore during operation. One chain element happened to accelerate towards the patients belly and perforated the abdominal wall. Computer tomography located the radiopaque projectile to the cortex of the left kidney and showed a lesion of the tail of the pancreas. The presence of intraperitoneal free air suggested a gastrointestinal perforation. Immediate open exploration of the peritoneal cavity and the retroperitoneal space revealed perforating lesions of the anterior and posterior gastric wall, as well as the pancreatic tail. The projectile was finally retrieved in the upper pole of the left kidney. The patient had a good clinical course subsequent to surgery and was discharged in good general condition.ConclusionThis case represents a rare form of a retained bullet injury and corroborates the need of sufficient measures of worker-protection in area of diamond-studded wire cutting devices.
Highlights
There are numerous cases of abdominal injuries due to bullets
An unusual case of an abdominal perforation caused by a metal projectile, lead to confusion in the interpretation of the preoperative computer tomography because of unknown mechanism of injury
We report the case of a male worker hit by a chain link after rupture of a special diamond-studded wire
Summary
An unusual case of an abdominal perforation caused by a metal projectile, lead to confusion in the interpretation of the preoperative computer tomography because of unknown mechanism of injury. We report the case of a male worker hit by a chain link after rupture of a special diamond-studded wire. These kind of wires are (page number not for citation purposes). A low output pancreatic fistula closed 8 weeks after endoscopic retrograde pancreaticoscopy with placement of a decompressing stent to the common duct four days after surgery [Figure 2B]. The patient was transferred to regular ward and discharged from hospital in good condition and closed wounds after closure of the pancreatic fistula. The stent could be removed on an outpatient basis without any complications after 4 month
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