Survival after penetrating Shrapnel to the Heart and Colon: Which Injuries to tackle First?

Abstract

Aim: To report on the clinical course of a patient who received penetrating shrapnel to the heart and colon.Background: Penetrating missiles to the heart is a highly lethal incident, particularly, when associated with other serious injuries.Case report: This is the case of a 29-year-old male soldier, who sustained multiple shrapnel injuries caused by an explosive device in the war zone. Shrapnel penetrated the cecum and another lodged in the interventricular septum of the heart. Surprisingly, the patient was stable enough to undergo a staged procedure, where he was subjected to limited right hemicolectomy first, followed by open heart surgery to extract the cardiac shrapnel twelve hours later. His convalescence was uneventful and was discharged in a good condition. Conclusion:With timely intervention and close collaboration between the concerned clinicians in specialized centers, patients with penetrating shrapnel to vital structures, including the heart, could have a successful outcome.Clinical significance: Critical thinking is needed to prioritize which injuries to deal with first, in patients with near lethal injuries.