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Case Reports
, 2018, 7839465

Nonoperative Management of Multiple Penetrating Cardiac and Colon Wounds From a Shotgun: A Case Report and Literature Review

Case Reports

Nonoperative Management of Multiple Penetrating Cardiac and Colon Wounds From a Shotgun: A Case Report and Literature Review

Paula M Jaramillo et al. Case Rep Surg.


Introduction: Surgery for cardiac trauma is considered fatal and for wounds of the colon by associated sepsis is normally considered; however, conservative management of many traumatic lesions of different injured organs has progressed over the years.

Presentation of the case: A 65-year-old male patient presented with multiple shotgun wounds on the left upper limb, thorax, and abdomen. On evaluation, he was hemodynamically stable with normal sinus rhythm and normal blood pressure, no dyspnea, or abdominal pain. Computed tomography (CT) scan of the chest shows hematoma around the aorta without injury to the blood vessel wall with an intramyocardial projectile without pericardial effusion. CT scan of the abdomen showed pellets in the transverse colon and descending colon endoluminal without extravasation of contrast medium or intra-abdominal fluid. The patient remains hemodynamically stable, and nonsurgical procedure was established.

Discussion: Patients with asymptomatic intramyocardial projectiles can be safely managed without surgery. Nonsurgical management is only possible in asymptomatic patients with trauma of the colon through close surveillance and with very selective patients since standard management is surgery.

Conclusion: Nonsurgical management of cardiac trauma, as well as colon penetrating trauma, can be performed in carefully selected patients with proper clinical follow-up, imaging, and laboratory studies.


Figure 1
Figure 1
Thoracic CT shows hematoma around the aorta with no wall wound. Echocardiogram shows bullet in the tricuspid valve ring without perforation (arrow).
Figure 2
Figure 2
Abdominal computed tomography (CT) shows bullet fragments in the endoluminal descending colon (top arrow). Bullet migration located in the descending colon upon initial CT scan is now located in the rectal ampulla (bottom arrow).

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    1. Russell R., Clasper J., Jenner B., Hodgetts T. J., Mahoney P. F. Ballistic injury. BMJ. 2014;348 doi: 10.1136/bmj.g1143. - DOI - PubMed
    1. Hill P. F., Edwards D. P., Bowyer G. W. Small fragment wounds: biophysics, pathophysiology and principles of management. Journal of the Royal Army Medical Corps. 2001;147(1):41–51. doi: 10.1136/jramc-147-01-04. - DOI - PubMed
    1. Wall M. J., Tsai P., Mattox K. L. Heart and thoracic vascular injuries. In: Mattox K. L., Moore E. E., Feliciano D., editors. Trauma. 7th. New York, NY, USA: McGraw-Hill; 2013. pp. 485–511.
    1. Kaljusto M. L., Skaga N. O., Pillgram-Larsen J., Tonnessen T. Survival predictor for penetrating cardiac injury; a 10-year consecutive cohort from a Scandinavian trauma center. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2015;23(1):p. 41. doi: 10.1186/s13049-015-0125-z. - DOI - PMC - PubMed
    1. Lateef Wani M., Ahangar A. G., Wani S. N., Irshad I., Ul-Hassan N. Penetrating cardiac injury: a review. Trauma Monthly. 2012;17(1):230–232. doi: 10.5812/traumamon.3461. - DOI - PMC - PubMed

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