Abstract
A 60-year-old man was hit by a shotgun blast from a distance of 15 meters. The blast hit his head, thoracoabdominal area, and upper left arm. On chest and abdominal X-ray examinations, 39 buckshot pellets were seen in the left lateral thoracoabdominal region. Chest CT revealed tearing of the left lung muscles and hemopneumothorax. A thoracic drain released air and 100 ml of blood. Urgent laparoscopy was performed for suspected alimentary canal damage. One pellet was removed from the serous surface of the descending colon and another from the splenic hilum. Some bleeding was observed, but there was no intestinal puncture. On day 18, 7 pellets were removed from the lung, 1 from the pericardium, and 15 from the thoracic subcutaneous fat and muscle layers. The patient's blood lead concentration was 12.0 μg/dl (maximum normal level <10 μg/dl) on day 17, but it decreased to 9.9 μg/dl over the next 2 weeks.
Physicians should note the possibility of lead poisoning from shotgun wounds affecting internal organs. Indications of lead poisoning are fatigue, digestive symptoms, central nervous symptoms, anemia, and nephrotoxicity. In the absence of bleeding and critical internal damage, elective surgery may be sufficient for removal of the buckshot and prevention of lead poisoning.
