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He nailed it

Hugo Bonatti. University of Maryland Community Medical group

Background: Nail guns are powerful tools and are widely used. Injuries with these devices may be devastating due to the significant force they can deploy.

Patients and methods: We herein report a first case of a self inflicted abdominal injury with a nail gun.

Results: A 55 year old male with history of coronary artery disease, type 2 DM and early signs of dementia attempted to refill a nail gun. He lodged the device against his right abdomen while the air hose was still attached and then accidently fired 2 nails into his abdomen. After he unsuccessfully tried to pull the nails out he drove himself 25 minutes to our emergency room. He was hemodynamically stable on arrival; pain control was achieved, antibiotics were given and he received tetanus immunization. CT-scan showed the two foreign bodies penetrating from the RUQ with one reaching the transverse colon. On emergency laparoscopy, the nails were found to have penetrated the thick omentum and the puncture site of one nail into the colon was identified. The omentum was resected off the colon and the right colon was completely mobilized. No additional injuries were found. The entrance area of the nails was then used to create a loop colostomy. The postoperative course was initially uneventful but the patient developed a severe posttraumatic inflammatory reaction of the fat tissue in the right upper quadrant and had to be readmitted for pain control and antibiotics were again administered. He recovered and was discharged with a plan for laparoscopically assisted colostomy closure after 6 weeks.

Discussion: To the best of our knowledge this is the first reported isolated colonic injury by a nail gun. Given the tremendous force of the device with unknown collateral damage to the surrounding tissue it was decided to manage the accident with a laparoscopic assisted colostomy using the entrance point of the nails for fecal diversion.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87338

Program Number: P065

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

39

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