Abdominal perforation after rupture of a diamond-studded wire: a case report.
BACKGROUND
There are numerous cases of abdominal injuries due to bullets. Abdominal injuries due to bullets are a diagnostic and therapeutic challenge. Here, an unusual case of an abdominal perforation caused by a metal projectile, lead to confusion in the interpretation of the preoperative computer tomography.


METHODS
We present an unusual case of a 32-year-old male worker who sustained a "shot" to the left upper abdominal quadrant, as a result of a work-related accident. The projectile derived from a special wire that tore during operation. One chain element happened to accelerate towards the patients belly and perforated the abdominal wall. Computer tomography located the radiopaque projectile to the cortex of the left kidney and showed a lesion of the tail of the pancreas. The presence of intraperitoneal free air suggested a gastrointestinal perforation. Immediate open exploration of the peritoneal cavity and the retroperitoneal space revealed perforating lesions of the anterior and posterior gastric wall, as well as the pancreatic tail. The projectile was finally retrieved in the upper pole of the left kidney. The patient had a good clinical course subsequent to surgery and was discharged in good general condition.


CONCLUSIONS
This case represents a rare form of a retained bullet injury and corroborates the need of sufficient measures of worker-protection in area of diamond-studded wire cutting devices.
Schmelzle
Moritz
M
Department of General Surgery, Heinrich-Heine-University Düsseldorf, Germany. moritz.schmelzle@med.uni-duesseldorf.de.
Matthaei
Hanno
H
Tustas
Roy Y
RY
Schmitt
Marcus
M
Müller-Mattheis
Volker
V
Linhart
Wolfgang
W
Eisenberger
Claus F
CF
Knoefel
Wolfram T
WT
Esch
Jan Schulte Am
JS