Vagoglossopharyngeal-Associated Syncope Due to a Retained Bullet in the Jugular Foramen

Link, Michael J.; Driscoll, Colin L. W.; Esquenazi, Yoshua

doi:10.1055/s-0029-1225532

Cited by 3 publications

(3 citation statements)

References 28 publications

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“…Based on our literature search, this study is the first to evaluate injury due to penetration of steel factory projectile to the musculoskeletal system. Foreign bodies such as bullets, shotgun pellets, and shrapnel can cause clinical symptoms by mechanical compression [6], lumen obstruction [7], irritation of nearby structures [8], systemic heavy metal intoxication [9], or tumour formation [10,11]. Chong et al have proposed the use of particle-based computational methods to simulate injury and haemorrhage in the human body, and their study demonstrates a significant haemorrhage following a ballistic injury to the leg [12].…”

Section: Discussionmentioning

confidence: 99%

A Potentially Dangerous Industrial Projectile Lodged in the Leg of a Steel Factory Worker

Khurana

Jain

Gupta

et al. 2021

Cureus

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Penetrating injuries due to fragments energized by an explosive event are life/limb-threatening and are associated with poor clinical and functional outcomes. Penetrating injuries are commonly inflicted in attacks with explosive devices. The extremities, especially the leg, are the most commonly affected body areas, presenting a high risk of infection, slow recovery, and the threat of amputation. This report presents a case of a young factory worker who sustained an injury to the leg with a foreign body lodged near the neurovascular bundle.A 44-year-old gentleman sustained a projectile injury while working in a stainless steel factory from the rula (steel rolling) machine with a foreign body getting lodged in the leg in March 2019. He was initially managed with wound care and didn't report any functional impairment. Gradually patient developed numbness and claudication symptoms of the foot over the next couple of years. He was subsequently operated on in 2021 for removal of the stainless steel foreign body encased in dystrophic calcification close to the tibial nerve and posterior tibial vessels. Interestingly the entry point of the foreign body was on the anterolateral aspect of the leg. The foreign body was removed using the postero-lateral approach to the tibia with careful dissection close to the neurovascular bundle. At a follow-up of 3 months, the patient is symptom-free with significant improvement of limb function.The authors propose that the foreign body crossed the interosseous membrane to get lodged close to the posterior tibial neurovascular bundle. In such a scenario, the patient was extremely lucky to have survived an amputation or significant functional injury of the limb. Proper protective equipment is needed not only for the torso but also for extremities to protect industrial workers from such limb-threatening injuries. Moreover, primary care physicians should be sensitised for the proper management of such injuries.

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Section: Discussionmentioning

confidence: 99%

A Potentially Dangerous Industrial Projectile Lodged in the Leg of a Steel Factory Worker

Khurana

Jain

Gupta

et al. 2021

Cureus

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“…Foreign bodies such as bullets, shotgun pellets, and shrapnel can cause clinical symptoms by mechanical compression [43], lumen obstruction [44], irritation of nearby structures [45], systemic heavy metal intoxication [5], or tumor formation [46–49]. The first report of the systemic toxicity of the retained bullet dates back to the eighteenth century.…”

Section: Discussionmentioning

confidence: 99%

Examination of metal mobilization from a gunshot by scanning acoustic microscopy, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and inductively coupled plasma optical emission spectroscopy: a case report

et al. 2018

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BackgroundProjectile foreign bodies are known to cause chronic heavy metal toxicity due to the release of metal into the bloodstream. However, the local effect around the metallic object has not been investigated and the main goal of our study is to examine the influence of the object in close proximity of the object.Case presentationA 36-year-old Caucasian woman with one metallic pellet close to her sciatic nerve due to a previous shotgun injury at the gluteal area presented with a diagnosis of recurrent lumbar disk herniation at L4–5 level. A physical examination confirmed chronic neuropathy and she underwent a two-stage surgery. The surgery included removal of the foreign body, followed by discectomy and fusion at the involved level. During the removal of the metallic foreign body, a tissue sample around the pellet and another tissue sample from a remote area were obtained. The samples were analyzed by scanning acoustic microscopy, scanning electron microscopy, and energy-dispersive X-ray spectroscopy. Lead, chromium, copper, cadmium, iron, manganese, selenium, and zinc elements in tissue, blood, and serum specimens were detected by inductively coupled plasma optical emission spectroscopy.ConclusionsAn acoustic impedance map of the tissue closer to the metallic body showed higher values indicating further accumulation of elements. Energy-dispersive X-ray spectroscopy results confirmed scanning acoustic microscopy results by measuring a higher concentration of elements closer to the metallic body. Scanning electron microscopy images showed that original structure was not disturbed far away; however, deformation of the structure existed in the tissue closer to the foreign body. Element analysis showed that element levels within blood and serum were more or less within acceptable ranges; on the other hand, element levels within the tissues showed pronounced differences indicating primarily lead intoxication in the proximity of the metallic body. We can state that residues of metallic foreign bodies of gunshot injuries cause chronic metal infiltration to the surrounding tissue and induce significant damage to nearby neural elements; this is supported by the results of scanning acoustic microscopy, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and inductively coupled plasma optical emission spectroscopy.

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“…Small case series and isolated case reports, however, have described the rare consequences of this management practice with reported complications including arthritis, 2 , 3 infection, 4 -6 bullet migration, 7 , 8 chronic pain, 9 neurogenic claudication, 10 local infl ammatory reactions, 11 and elevated blood lead levels. In adults, it is standard practice to leave retained bullets in situ when they are inaccessible, when removal may cause more extensive tissue damage, or if there is a perceived low risk of long-term complications from bullet retention.…”

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confidence: 99%

The Long-term Outcome of Retained Foreign Bodies in Pediatric Gunshot Wounds

Mazotas

Hamilton

McCubbins

et al. 2012

Journal of Trauma Nursing

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The purpose of this retrospective review was to determine the long-term consequences of retained bullet foreign bodies in children after gunshot injury. All children managed for gunshot wounds at an urban, level I pediatric trauma center were evaluated, identifying those discharged with retained bullet foreign bodies. Overall, 244 children were treated for gunshot wounds, 107 (44%) had retained foreign bodies, 24 (22%) experienced long-term complications related to retained foreign bodies, and 14 (13%) required removal. Complications occur in a significant subset of pediatric patients with retained bullets. Prophylactic bullet removal appears unnecessary, although close outpatient follow-up is warranted.

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Vagoglossopharyngeal-Associated Syncope Due to a Retained Bullet in the Jugular Foramen

Cited by 3 publications

References 28 publications

A Potentially Dangerous Industrial Projectile Lodged in the Leg of a Steel Factory Worker

A Potentially Dangerous Industrial Projectile Lodged in the Leg of a Steel Factory Worker

Examination of metal mobilization from a gunshot by scanning acoustic microscopy, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and inductively coupled plasma optical emission spectroscopy: a case report

The Long-term Outcome of Retained Foreign Bodies in Pediatric Gunshot Wounds

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