Pellet Injuries Research Articles

PLAIES ABDOMINALES PAR ECLATS DE PLOMB

We report a case of a patient with air gun pellet injuries to the abdomen. This was treated conservatively, and the pellet was passed per rectum 24 hours after the injury. then the patient evolved favourably. Gunshot wounds to the abdomen do not necessarily warrant immediate laparotomy, but conservative management using signs of peritoneal irritation or progressive abdominal tenderness are the best indicators of the need for operation.

Air-gun pellet injuries to the head and neck

Air-gun pellet injuries (AgPI) of the central nervous system (CNS) are rare but catastrophic events. They occur mostly in children and young adults. The entrance is usually either through the orbit or through the neck and the entry wound is so small that it may be disregarded on physical examination in the emergency room. Early recognition and correct management of the possible complications of AgPIs is important and may prevent a poor outcome. METHODS We intend to present our experience with 16 cases of AgPIs of the head and neck referred to the department of neurosurgery during the last 15 years. The characteristic findings on physical examination of the cases and the imaging studies performed are described. Special management undertaken for the rare complications are mentioned and a short literature review is performed on each entity. RESULTS All our cases happened in the first and second decades of life and only in boys playing with toy guns. There were 12 head and face and four neck wounds. Damaged globe that had to be exenterated was the earliest complication, handled by ophthalmologists (four cases). Cerebrospinal fluid (CSF) leakage, meningitis, brain abscess formation, development of traumatic aneurysm (TA), carotid-cavernous sinus fistula (CCF), wandering intracerebral and intraventricular pellet, and splitting of the pellet after striking hard bone were the complications noted. In addition to plain X-ray films, computed tomography (CT) scanning and angiography were diagnostic procedures of choice. CONCLUSIONS The present series of patients is the largest collection of AgPIs to the head and neck reported in the literature in which nearly all the possible complications of such injuries have been reviewed. Early recognition and awareness of the possible cumbersome complications of such a minor penetrating wound can prevent major catastrophies in this young group of victims.

Air gun pellet injuries: The safety of MR imaging

The ferromagnetism, and therefore the safety in a magnetic resonance (MR) examination, of the most widely available air gun pellets has been tested. While many are made of lead and are not ferromagnetic, some contain steel and are deflected strongly in a magnetic field. There must therefore be careful consideration before undertaking MR examinations of patients with embedded air gun pellets.

Projectile Metallic Foreign Bodies in the Orbit: A Retrospective Study of Epidemiologic Factors, Management, and Outcomes

Intraorbital projectile metallic foreign bodies are associated with significant ocular and orbital injuries. The authors sought to evaluate epidemiologic factors, the incidence of associated ocular and orbital injury, and the nature and necessity of surgical intervention in these cases. Charts of all patients with projectile intraorbital metallic foreign bodies seen at our institution (27) over the preceding 7 years were evaluated with respect to age, sex, type of injury, associated ocular and orbital injuries, location of the projectile (anterior, epibulbar, or posterior), postinjury visual acuity, and surgical intervention. The majority of patients were male, between the ages of 11 and 30, and had BB pellet injuries. Thirteen projectiles were lodged anteriorly, 4 were in an epibulbar position, and the remaining 10 were posterior to the equator. Twelve of 13 anterior, and 4 of 4 epibulbar foreign bodies were removed surgically, whereas only 2 of 10 posterior foreign bodies required surgery. No case of surgical intervention resulted in a decrease of visual acuity. Associated ocular injuries were both more common and severe in patients with posteriorly located foreign bodies. Final visual acuity was better at presentation and at discharge in patients with anteriorly located foreign bodies. Intraorbital projectile metallic foreign bodies can be a source of significant ocular morbidity. Management of these cases is dependent on the location of the projectile. Ancillary radiographic studies can be helpful. Surgery to remove the projectile should be considered in each case, but foreign bodies that are not readily accessible often may be left safely in place. Closer regulation of the pellet gun industry, with an emphasis on education and protective eyewear use, would be helpful in reducing these injuries.

Venous Bullet Embolism: A Complication of Airgun Pellet Injuries

Bullet emboli are an interesting but rare occurrence and their management when situated in the venous system remains controversial. Two cases of venous bullet embolism to the right heart are reported due to airgun pellet injuries. Both cases required bullet embolectomy using cardio-pulmonary bypass.

Bilateral Ocular Shotgun Injury

We retrospectively studied 14 patients with bilateral ocular shotgun injury in order to determine overall visual prognosis and factors affecting individual prognosis. Although only eight of 28 eyes (29%) in this series recovered visual acuity of 20/100 or better, six of 14 patients (43%) recovered at least 20/100 and eight of 14 patients (57%) recovered visual acuity of at least 20/400. Tissue destruction in the form of severe ocular disorganization or direct injury of optic nerve or macula was the primary limiting factor to visual recovery in 16 of 20 eyes (80%) not recovering to 20/100, while retinal detachment was the limiting factor in only four of these 20 eyes (20%). While extensive ocular disorganization, direct optic nerve or macular injury, no light perception on initial examination, and multiple pellet injuries were predictive of poor outcome, retinal detachment and double perforating injury were not.

Airgun pellet injuries : Cairn D. and Weeks R. F. (1983) A new danger associated with airgun pellet injuries. Br. Med. J.286, 21

Airgun pellet injuries : Cairn D. and Weeks R. F. (1983) A new danger associated with airgun pellet injuries. Br. Med. J.286, 21

The intraocular foreign body. Principles and problems in the management of complicated cases by pars plana vitrectomy.

In a retrospective study, the results of pars plana vitrectomy in treatment of injuries with intraocular foreign bodies were described. The patient material was subdivided into five different groups. In 41.6% of the cases, practical blinding could not be prevented. A visual acuity of 0.2 and better was present in 26.6% of the cases. The preoperative (45%) and postoperative (30%) traumatic retinal detachment have an extremely unfavorable prognosis with a reattachment rate of 40 or 21% respectively. The results in the treatment of injuries with magnetic splitters and their sequelae are very much better than those with nonmagnetic foreign bodies. The gunshot and air rifle pellet injuries were the most unfavorable group.

Points: A new danger associated with airgun pellet injuries

Points: A new danger associated with airgun pellet injuries

A new danger associated with airgun pellet injuries

A new danger associated with airgun pellet injuries

Shotgun Wounds: Multiple Probes and Shielding Effects as Adjuncts to Determining Position of the Deceased at Time of Injury

Careful and meticulous probing of sites of individual pellet injuries in distant shotgun wounds with repositioning of the body to allow parallel alignment of pellet tracts make possible the determination of the position of a decreased at time of injury. Spared areas, or "gaps," within the pattern may result from shielding either by body parts or by an intermediate object. The present case reports illustrate the method and its importance.

Selective management of gunshot wounds to the neck: Report of a series and review of the literature

Thirty-two patients with gunshot wounds to the neck, 13 with multiple pellet injuries and 19 with single missile injuries, were managed selectively. Although 3 of the 32 patients died in the hospital, no death was attributable to the neck injury. This experience and a review of the literature support the concept of selective management of penetrating neck injuries with intervention based on specific indications.

Ocular injuries caused by airgun pellets: an analysis of 105 cases.

One hundred and five cases of airgun pellet injuries of the eye have been analysed. The average age was 14 and the male to female ratio 7.5:1. Forty-five patients had final visual acuities of 6/18 or less in the injured eye and 19 of these had the eye removed. The two main causes for poor vision were retinal damage and cataract. One patient became completely blind after sympathetic ophthalmitis arising 11 years after the injury. The pellet lodged in the orbit in 14 cases and three of these, together with one who had an intraethmoidal pellet, were investigated for abnormal lead levels in blood and urine. The results were normal.The circumstances of the injury were obtained in 12 cases and most involved careless handling of a gun. Instruction of children and parents in schools and on television, rather than stricter legislation, is suggested as a means of prevention.