神経外傷
Online ISSN : 2434-3900
症例報告
ネイルガンによる穿通性心損傷および脳損傷の1例
小野寺 康暉古峰 弘之土屋 亮輔栢原 智道寺西 亮雄武 裕士郎吉武 明弘中嶋 博之根本 学栗田 浩樹
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2021 年 44 巻 2 号 p. 55-59

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Nail gun injuries often occur in the extremities, but im­portant organs such as the heart and brain can be damaged in some cases. Some of them result in several wounds and require urgent surgical interventions. Because injuries of multiple organs are extremely rare, the priority of surgical treatments is not established and should be considered according to each case. Herein, we report a case of penetrating heart and head injuries caused by a nail gun. A 44–year–old man was admitted to our institute after shooting himself using a nail gun the previous day. His conscious­ness was clear without the neurological deficit and his vital signs were stable despite the vital organ injuries. Chest Computed Tomography (CT) scan showed a nail penetrated his heart and head CT revealed the tips of 2 nails reached the right frontal lobe and the right temporal lobe respectively, but they did not indicate cardiac tamponade and intracranial hemorrhage. The other 4 nails around the oc­cipital and cervical portion did not reach the intracranial and stopped in the subcutaneous tissue. After consultation with cardiovascular surgeons, we decided to perform sur­gery on his heart first, because the nail can get deeper and destroy his heart owing to its beat. It was performed using a cardio–pulmonary bypass under heparin administration. After measuring activated clotting time, we confirmed that the effect of heparin had disappeared, and started cranio­tomy. All the nails were successfully removed. The postoperative course was uneventful without neurological defi­cit and complications, and he was discharged on the 16th postoperative day. In the case of multiple organ injuries, rational strategy and earlier surgical interventions are in­dispensable for a good prognosis.

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