J Trauma Inj.  2023 Sep;36(3):253-257. 10.20408/jti.2022.0073.

Penetrating right ventricular injury following a single gunshot to the left flank in Iraq: a case report

• Majeed ZS
• Othman YN
• Ali RK

• KMID: 2547099
• DOI: http://doi.org/10.20408/jti.2022.0073

Abstract

A century ago, cardiac injuries usually resulted in death. However, despite all the advances in medicine, these injuries still have high mortality and morbidity rates. In the present case, we describe a patient with a bullet injury to the right ventricle who survived at our hospital despite the limitations of our center with regard to modalities and equipment. A 30-year-old man was brought to our emergency department with a bullet wound to his left flank. He was hemodynamically unstable. After only 8 minutes in the hospital and without further investigations he was rushed to the operating room. During laparotomy, a clot was visible in the left diaphragm, which dislodged and caused extensive bleeding. The decision was made to perform a sternotomy in the absence of a sternal saw. An oblique 8-cm injury to the right ventricle was discovered following rapid exploration. It was repaired without the need for cardiopulmonary bypass surgery. After a few days in the hospital, the patient was discharged home. In the event of a penetrating cardiac injury, rapid decision-making is crucial for survival. Whenever possible, the patient should be transferred to the operating room, as emergency department thoracotomies are associated with a high mortality rate.

Keyword

Penetrating cardiac injury; Gunshot; Heart ventricles; Sternotomy; Emergency department thoracotomy; Diagnostic imaging; Case reports