Abstract:
Background: Pulmonary artery embolization due to projectile embolus is a rare complication in combat patients.
Such embolization is rare for combat patients in the ongoing armed conflict, in East Ukraine since 2014.
Case presentation: We report a clinical case of a 34-year-old Caucasian combat patient who was injured after an
explosion of a booby trap hand grenade. This soldier was diagnosed with severe abdominal and skeletal trauma:
damage of the duodenum and transverse colon, internal bleeding due to inferior vena cava damage and fractures
of both lower extremities. The patient was treated at a highly specialized surgical center within the “golden hour”
time. Whole-body computed tomography scan was performed as a routine screening method for hemodynamically
stable patients, at which we identified a projectile embolus due to the explosion of a booby trap hand grenade in
the right midlobar pulmonary artery. Our patient had no clinical manifestation of pulmonary artery embolism. At
follow-up, our patient was diagnosed with the following complications: multiple necrosis and perforations of the
transverse colon leading to a fecal peritonitis; duodenum suture line leakage caused the formation of a duodenal
fistula; postoperative wound infection. These complications required multiple secondary operations, and in
accordance to the principles of damage-control tactics, the extraction of projectile-embolus was postponed. Open
surgery retrieval of the metal fragment was successfully performed on the 80th day after injury. Our patient was
discharged from the hospital on day 168th after injury.
Conclusions: Literature analysis shows a significant difference of clinical management for patient with projectile
embolism in hybrid war settings as compared to previously described cases of combat and civil gunshot injuries.
Damage control tactics and the concept of the “golden hour” are highly effective for those injured in a hybrid war.
A whole-body computed tomography scan is an effective screening method for asymptomatic patients with
projectile-embolism of the great vessels.
The investigation of a greater cohort of combat patients with severe injuries and projectile-embolism should be
performed in order to develop a better guideline for these patients and to save more lives.
