It is known that almost 50% of heart injury victims die at the trauma site or in transportation. This study presents a case of firearm wound with intra-cardiac injury treated with extracorporeal circulation at the emergency service. A 19 year-old male patient with two gunshot wounds: one in the right thoracic-abdominal transition without exit orifice and the other in the right gluteus with right thigh exit. After angiotomography, with evidence of projectile inside the cardiac chamber and a lesion in the extraperitoneal rectum, a surgical procedure was indicated. Firstly, an access to the thoracic cavity was made by performing a longitudinal anterior sternotomy. Then, after opening the pericardial cavity, an entry orifice of the projectile in the anterior wall of the Right Ventricle and a large clot buffering the wound could be observed. The extracorporeal circulation was installed. The right atrial cavity without lesions was visualized after performing wide right atriotomy. A small incision was performed in the atrial septum for decompression. The Tricuspid cusps were exposed by the retractor showing the ventricular septum. The projectile was located between the posterior papillary muscle and the chordae tendineae. The exploratory laparotomy showed two extraperitoneal rectum lesions. Protective colostomy (sigmoidostomy in a loop), pre-sacral drainage, and distal stump washout were performed. The outcome was highly satisfactory.
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