Management of an Unexploded Intracorporeal Firework in a Low Resource Setting: Case Report and Tips

Abstract

Surgical removal of unexploded ordnance has been described in literature, usually in the context of the military. We describe a case of a 31-year-old gentleman who presented with a traumatic fireworks injury resulting in an unexploded three-inch aerial shell lodged in his left upper thigh. The sole regional Explosive Ordinance Disposal (EOD) expert was not available, so a local pyrotechnic engineer was contacted and he helped in identification of the firework. The firework was removed without the use of electrocautery, irrigation, or metal instrument contact after skin incision. The patient recovered well after prolonged wound healing. Creativity needs to be employed in low resource settings to identify all available resources that can impart knowledge when medical training is not enough. People with knowledge of explosives can be, as in our case, local pyrotechnics engineer or can be local cannon enthusiasts, veterans, or active military personnel at a nearby military base.

Surgical removal of an impaled unexploded mortar shell into the chest: Case review from a war-zone

“…This case reviews an uncommon form of war-related injuries caused by an impaled mortar shell and documents the patterns of associated injuries. The surgical detonation of live explosives has been documented in the literature since 1942, mostly in connection with military operations [ 2 , 7 , 8 ]. Unexploded munitions have been reported scarcely in the literature.…”

“…The Explosive Ordnance Disposal (EOD) team must be immediately contacted for assistance in locating, removing, and disposing of the explosive ordnance. The Five Point Protocol (5Cs) is described in military manuals for unexploded ordnance situations [ 2 , 8 ]. These include ensuring the area is “confirmed”, clearing the site, establishing a perimeter, cordoning off the area, checking the area, and exercising “control” over the situation [ 2 , 8 ].…”

“…The Five Point Protocol (5Cs) is described in military manuals for unexploded ordnance situations [ 2 , 8 ]. These include ensuring the area is “confirmed”, clearing the site, establishing a perimeter, cordoning off the area, checking the area, and exercising “control” over the situation [ 2 , 8 ]. Other tactics include using barricades and wearing body armor.…”

“…The surgical management of injuries caused by fireworks is complicated due to the significant variations in arsenal design, injury mechanics, and involvement of vital organs [ 1 ]. In war zones, various forms of injuries, such as penetrating injuries from metal fragmentation or explosive blasts, are observed [ 2 ]. While these injuries typically result from direct artillery impact or explosions, instances of unexploded ordnance and munitions are infrequently documented in the literature [ [2] , [3] , [4] ].…”

“…In war zones, various forms of injuries, such as penetrating injuries from metal fragmentation or explosive blasts, are observed [ 2 ]. While these injuries typically result from direct artillery impact or explosions, instances of unexploded ordnance and munitions are infrequently documented in the literature [ [2] , [3] , [4] ]. Indeed, the management of unexploded munitions presents formidable challenges owing to their multifaceted nature, absence of clinical experience, and resource constraints endemic to the healthcare landscapes wherein these injuries manifest [ 5 ].…”