Introduction

Retained shrapnel from gunshots is a common occurrence; however, retained shrapnel within the spinal canal is exceedingly uncommon. Guidelines for removal and treatment of these cases are a difficult topic, as surgical removal is not necessarily without consequence, and retention can lead to possible further injury or a secondary disease process of plumbism, which can be difficult to diagnose in this population.

Case presentation

This case report provides a unique example of a young patient with retained shrapnel from a gunshot. This patient suffered an initial spinal cord injury due to a gunshot and secondarily presented with abdominal pain, fatigue, elevated blood lead levels, and was diagnosed with plumbism. This was addressed with operative removal of shrapnel and posterior instrumented spinal fusion, resulting in decreased lead levels and symptom resolution postoperatively.

Discussion

Lead toxicity risk in patients with retained shrapnel, particularly in the spine, warrants vigilant monitoring. While management guidelines lack consensus, symptomatic lead toxicity may necessitate intervention. Residual neurological deficits complicate evaluation, emphasizing individualized management decisions.

中文翻译：

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应对异物残留脊髓损伤的复杂性和铅中毒的诊断挑战——病例报告aaa

介绍

枪弹残留的情况很常见；然而，椎管内残留弹片的情况极为罕见。这些病例的切除和治疗指南是一个困难的话题，因为手术切除不一定没有后果，保留可能会导致可能的进一步损伤或继发性铅中毒，这在该人群中很难诊断。

案例展示

本病例报告提供了一个独特的例子，一名年轻患者身上残留着枪弹碎片。该患者最初因枪击造成脊髓损伤，随后出现腹痛、疲劳、血铅水平升高，并被诊断为铅中毒。通过手术移除弹片和后路脊柱融合术解决了这个问题，导致术后铅水平降低和症状缓解。

讨论

保留弹片的患者（尤其是脊柱）的铅中毒风险值得警惕监测。虽然管理指南缺乏共识，但有症状的铅中毒可能需要干预。残余的神经功能缺陷使评估变得复杂，强调个体化的管理决策。