Fan He, M.D *#,Shiqiang
Wang, M.D*, Changjiang Yu, M.D, Huaidong Chen,
M.D
Department of Cardiovascular Surgery, Sir Run Run Shaw Hospital, School
of Medicine, Zhejiang University, Hangzhou, China
*Fan He and Shiqiang Wang contributed equally to this work and are the
co-first authors.
# Correspondence: Fan He; Tel: +861758207467; E-mail:
hefan8917@zju.edu.cn.
Address: East qingchun Road 3th, Hangzhou, Zhejiang Province, China
A 23-year-old man committed suicide by
shooting
more than 10 nails into his chest with a nail gun 3 days ago. Physical
examination on admission showed stable vital signs without losing
consciousness (Glasgow Coma Scale: E4V5M6) and limb weakness(muscle
strength with grade 4). Several scars and local eminence could be seen
on his left chest wall (Figure 1). Urgent CT examination revealed
exudation in the left lung and bilateral pleural effusion, especially at
the left. High density shadows in the left anterior chest wall, heart,
left lung and stomach were considered as foreign bodies(Figure2).
Massive pericardial effusion was also presented
(Figure
2B, 2C). Echocardiography also indicated a large pericardial effusion,
of which the widest part of the apex was about 12mm. We performed
emergency surgery on the patient through cardiopulmonary bypass.
A
total of 12 nails , about 5cm in length, were found (Figure 3A), of
which 6 penetrated the chest wall and the left ventricular wall, 3 nails
penetrated the middle and lower lobe of the left lung, 2 nails were
located in the chest wall, and the other nail was found to be located
near the gastric fundus on the anterior wall of the upper gastric body
through gastroscopy, with one side free and the other side trapped in
the gastric wall (Figure 3B).
The operation was performed with a median sternal incision assisted by
cardiopulmonary bypass, 11 nails were removed during the operation, the
ruptured left ventricle and the middle and lower lobe were repaired. The
nail in the stomach was removed endoscopically and the gastrointestinal
decompression tube was indwelling. The operation was successful, and the
patient was discharged successfully 2 weeks after the operation.