Firearms foreign body in neck
Introduction
Introduction to the neck firearm foreign body Firearmforeignbody occurs mostly in blind wars in wars or gun battles, more than 80% are shrapnel, and a few are bullets. In the early post-injury patients, there may be hemorrhage, shock and asphyxia. Inflammatory changes may occur in the tissues surrounding the foreign body, or the wound may not heal, forming an abscess or sinus. The movement or compression of some foreign objects may also cause damage and necrosis of the surrounding organs. Therefore, surgical removal should be performed in due course. basic knowledge Sickness ratio: 0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: coma, sepsis
Cause
Cause of cervical firearm foreign body
(1) Causes of the disease
Firearm injuries are classified into gunshot wounds and shrapnel injuries according to the wounded weapons. According to the nature of the wound, they are divided into penetrating wounds and blind tube wounds. Blind tube wounds often have foreign bodies remaining. According to statistics from the former Soviet Union, more than 80% of blind tube wounds are caused by shrapnel. The neck firearm foreign body is more common in the blind tube injury of the shrapnel. There are few foreign objects in the penetrating wound, which only accounts for about 1.5% of all penetrating injuries.
If a neck injury is combined with a penetrating injury to the trachea, esophagus, or throat, the body can pass through the wall of one side, fall into the lumen, or be inserted into the soft tissue of the contralateral neck.
There is only one foreign body in the neck, but there are many foreign objects scattered by the fire.
(two) pathogenesis
There are three types of neck and wounds with foreign bodies remaining in the body:
1. There is no significant inflammation around the foreign body and the wound heals.
2. There is inflammation around the foreign body, the wound does not heal, and an abscess or sinus is formed.
3. The compression and movement of foreign bodies cause damage and necrosis of surrounding tissues and organs, and complications occur.
Due to the rich blood vessels in the neck, anaerobic infection or tetanus in blind tube injuries is rare, secondary bleeding occurs frequently, and a solid envelope is often formed around the foreign body, which is not conducive to bacterial growth, but in the case of bruises, surgery In the case of flu or other febrile illness, the capsule is destroyed, which can cause the infection to recur.
Prevention
Neck firearm foreign body prevention
Daily life pay attention to the protection of the neck from injury, to prevent kicking and scratching, firearm injuries, etc. during play, fighting. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Neck firearm foreign body complications Complications, coma, sepsis
Complications include hemorrhage, shock, infection, tracheal injury, etc. Tracheal injury manifests as difficulty in breathing, subcutaneous or mediastinal emphysema in the neck, pneumothorax or tension pneumothorax, blood pneumothorax, and cyanosis. After the pneumothorax patient is placed in the chest drainage tube, the inhaled gas directly overflows from the chest tube, which makes the dyspnea and bronchial injury combined with different degrees of bleeding.
Symptom
Neck firearm foreign body symptoms Common symptoms Abscess traumatic shock asphyxia coma oropharyngeal foreign body sepsis
Clinical symptoms vary depending on the nature and timing of the injury, the location and size of the foreign body, and the presence or absence of combined injuries and complications.
Symptom
In the early stage after injury, shock, coma, hemorrhage, suffocation or breathing, swallowing, difficulty in vocalization, mid-term injury and infection due to foreign bodies, bleeding often occur, neck cellulitis and abscess, mediastinal inflammation, sepsis, cervical osteomyelitis, etc. In the advanced stage, there are often sequelae of sinus, scarring, and neural crest.
The shrapnel in the soft tissue of the neck, especially the pointed warhead, can move due to its own gravity and muscle contraction, resulting in difficulty in surgery or destruction of vital organs, causing serious complications. Gunshots entering the blood vessel can be along the artery or vein. The blood flow moves, causing vascular damage. Kakpapob reported that a bullet flicked through the internal jugular vein through the heart into the pulmonary artery and finally stayed in the hilar region.
2. Physical examination
(1) Wound: The wound with a single entrance (blind tube injury) indicates that there is foreign matter remaining. When the wound entrance or exit is located in the nose, throat or mouth, these parts must be examined in detail, if accompanied by a throat, trachea, and esophageal penetrating injury. At the time, the body may fall into the lumen, so the neck examination seems to be a blind tube injury, in fact, no foreign matter remains.
(2) Palpation: superficial foreign body can be touched by fingers or probes. When there is a sinus, inserting a blunt probe may touch foreign objects. The wounds that have been healed according to foreign body dysfunction, pain and tenderness can be Predict the location of the foreign object.
Care should be taken to check for fresh wounds in the neck. If there is no good lighting and first aid equipment, avoid rushing to find blood clots and foreign bodies in the wound to avoid bleeding.
Examine
Examination of cervical firearm foreign bodies
1. X-ray fluoroscopy: changing the patient's position for fluoroscopy, combined with the neck or pharyngeal finger palpation, not only can find foreign objects, but also can identify the movement of foreign objects and its relationship with surrounding structures during neck activity, embedded The foreign body of the throat or thyroid often moves with the throat when swallowing, and the pulsation movement of the foreign body near the common carotid artery can be seen (the film has a double edge with the shadow of the foreign body).
In order to determine the relationship between the foreign body and the metal instrument in the wound during surgery, a contrast perspective can be made, or the needle can be inserted as a direction mark to calibrate the exact position of the foreign object under fluoroscopy.
2. X-ray film: the positive side of the neck can determine the location, size, shape and foreign body caused by complications and bone damage (cervical vertebrae, hyoid bone, etc.), through the natural tunnel (or injury, sinus) Putting a metal logo to help determine the depth of the foreign body, there are those who have a fistula, such as fistula angiography, skull base, paravertebral and pterygopalatine and other deep foreign objects, can be properly selected in the neck, face or pharynx before surgery. The part penetrates into the needle position.
It must be noted that the positive lateral radiograph of the neck can only guide the operator to find foreign objects if the foreign body is immediately adjacent to and embedded in the cervical vertebra. If the foreign body is embedded in the soft tissue away from the cervical vertebra, the positive lateral radiograph may not find foreign matter. It is because the position of the patient on the operating table is different from that during the filming. During neck surgery, the patient generally takes the supine head to extend backwards and deflects to the opposite side. At this time, the foreign body moves, and the patient should be placed in the operation before the operation. The position is re-photographed in order to guide the operator to find foreign objects.
3. CT and MRI scans: CT and MRI are superior to traditional X-ray examinations in determining the location of foreign bodies and understanding the complications caused by foreign bodies.
Diagnosis
Diagnosis and identification of cervical firearm foreign bodies
Diagnostic criteria
History
The patient had a firearm injury and was mostly a blind tube injury.
2. Clinical manifestations
Clinical examinations and symptoms support the presence of foreign bodies.
3. Imaging examination
Accurate positioning of firearm foreign bodies.
Differential diagnosis
This disease is generally not confused with other diseases.
