Retained bullet in the neck after gunshot wounds to the chest and arm in combat patient injured in the war in Ukraine: A case report

INTRODUCTION AND IMPORTANCE: A gunshot wound is the most common injury in armed conflicts, resulting in severe trauma and increased morbidity usually due to damage to major vessels. Gunshot injury could be associated with the projectile location in one anatomical area, but the initial inlet place in another. PRESENTATION OF CASE: A 33-years old male patient received gunshot injuries to the left axillary area of the chest and left upper extremity in the battlefield area near Kyiv (Ukraine). The patient was diagnosed with multiple gunshot injuries, as judged from the presence of inlet and outlet holes in the chest and left upper arm. Without having any major complaints, the patient was examined by chest X-ray, showing a metal density fragment in the area of the first left rib, behind the left clavicle and adjacent to the left common carotid artery (CCA) and internal jugular vein (IJV). Surgery revealed 25 mm retained bullet in the area between CCA and IJV. CLINICAL DISCUSSION: Our case report is in line with others, showing that identification of the bullet or projectile fragment in unexpected locations was made by chance or due to routine application of protocols for the clinical evaluation of combat patients, including those without clinical signs or specific complaints. CONCLUSION: A gunshot injury could be associated with an unusual bullet trajectory. A routine whole-body CT scan or chest and abdominal X-ray should be performed for all patients with gunshot injury of any localization for early detection of a possible retained bullet.