A lucky escape during a hunting accident: LANCET case report
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
A 59-year-old man reported to the hospital saying that he had been accidentally shot by a fellow hunter during an expedition to the local moorland. He was alone when he walked into the department. During physical examination he was found to be asymptomatic and all his vital signs were stable. His blood pressure was 125/75 mm Hg, and he did not complain of any dizziness or shortness of breath.

Furthermore, no active bleeding was noted. An emergency whole-body CT revealed that shotgun pellets were evenly distributed in his body—from his knees to his neck—and that some had penetrated internally to affect several organs. A CT scan of his chest also revealed that two of the pellets had reached the mediastinum: one had stopped a few millimetres from the floor of the aortic arch ( figure), and the other one penetrated the pericardium, stopping between the pericardium and the lateral wall of the left ventricle ( figure).

A CT angiogram demonstrated that no contrast agent was leaking from around the aorta or pericardium. Echocardiogram, revealed a small pericardial effusion, indicating that the patient was haemodynamically stable. The CT angiogram was repeated 24 h later, and, fortunately for the patient, nothing significantly had changed. At this stage, there were no indications for cardiac surgery to remove the pellets so—with the patient's agreement—it was decided to take no further action after having weighed up the pros and cons of undertaking high-risk cardiac surgery or leaving the pellets where they were.

After a few days of observation and antibiotic prophylaxis ceftriaxone (1 g a day for a week), the patient was discharged. He remained symptom-free when seen again several months later.

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)33001-0/fulltext