Bullet removal, erosion of blood vessel

[Christos Giannou]

Normally, the body reacts to the bullet, and any contaminants with it, by
forming a tough fibrous capsule that encapsulates the bullet: a foreign body
granuloma. This usually ends the problem for the vast majority of bullets
(the thousands of near misses); they don't move and don't erode. Simple
pressure, over time, usually with some very low grade infection (?) can
produce erosion of a major blood vessel. A thin-walled vein (IVC) would be
less resistant than a major artery (Aorta).

But these are the clinical cases that are reported in the surgical
literature. The thousands -- not to say tens or hundreds of thousands -- of
patients in whom this does not happen, are, obviously, not reported. The
specific case can be difficult to judge. One thing that you must keep in
mind of course before attempting to remove such a bullet is the possibility
of the surgeon inflicting greater harm than the bullet itself. That tough
fibrous capsule usually sticks to anything nearby and trying to find a plane
of dissection (between it and the Aorta?) can be very frustrating.


>
> ---------- Forwarded message ----------
> From: Ronald Simon <Traumamd at nyc.rr.com>
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Date: Mon, 06 Aug 2007 19:07:47 -0400
> Subject: Re: Bullet Removal
> Never heard of a bullet eroding years later. Always assumed that the
> ones that presented soon after injury were not erosions but were
> pseudo-aneuysms that ruptured. If they did erode wouldn't that
> necessitate the removal of thousands of near misses.
> What do you think?
> ron simon
>
> Andrew J Bowman wrote:
> > I was reading some of the recent postings at trauma.org website.
> >
> > There was one posting about the retro-aortic bullet that was left in
> place.
> >
> > Is there ever a concern about eventual erosion of the bullet into the
> nearby
> > vascular structures?
> >
> > I had a patient in my past who had suffered a GSW in his youth. He
> presented
> > to my ER late at night with abdominal pain and hypotension. CT showed
> > massive hemoperitoneum.
> >
> > OR showed that bullet had eroded into the IVC.
> >
> > Thanks,
> >
> > Andrew Bowman
> > --
>
-- 
christos giannou
Monemvasia Lakonia
23070 Greece
tel & fax: (++30) 27320-61772
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