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Intra-myocardial Bullet causing heart block in a patient with multiple gunshot wounds: Case Report

 

Authors: Odhiambo W.A. 1 BDS, MDS (OMFS), Guthua S.W. 1 BDS, MMED SC, DOMS, FIAOMS, FCS, Munene J. 2, MBChB,

 MMed, Kariuki C. 3, MBChB, Mmed, FRCP Thanga P.W. 3 MBChB. Affiliations: 1 Department of Oral and Maxillofacial Surgery, University of Nairobi, 2 Kenyatta National Hospital, Nairobi, 3 The Nairobi Hospital. Corresponding Author; Dr. Walter Odhiambo, Department of Oral and Maxillofacial surgery, School of Dental Sciences, College of Health Sciences. P.O. BOX 19676, KNH, NAIROBI Tel 254-20-3873398 Cell 254-722-518616. E-mail: walter.odhiambo@uonbi.ac.ke

 

Summary

Elective removal of intra-myocardial bullet remains a controversial subject. A non-operative approach has been recommended as appropriate for a stable asymptomatic patient. In the presence of complications such as bleeding, perforation leading to cardiac tamponade, thrombus formation, embolization, rhythm disturbances and infections, surgical removal may be advised. We present a patient who survived multiple gunshot wounds with a bullet lodged in the wall of the left ventricle of the heart. Details of the injuries sustained, operative removal of the bullet and the challenges that ensued are illustrated.

Introduction

 

Firearm injury is increasingly becoming a major pub-lic health problem in both developed and developing countries. The wounds caused by firearms, whether in assault, robbery, suicide or mass shootings, tend to be more lethal causing higher mortality and severer mor-bidity rates than other conventional weapons common-ly used in assault (1,2,3,4).

 

The injuries caused by firearms tend to be multiple even if arising from a single bullet and thus may involve mul-tiple organs and affect diverse systems. Highly skilled specialists from different surgical and clinical discipline may be required to save life and to rehabilitate these patients. Penetrating cardiac injuries can be particularly devastating.

 

Elective removal of intra-myocardial bullet remains a controversial subject among cardiothoracic surgeons. A non-operative approach has been recommended as appropri