A large foreign body removal from the anterior mediastinum using a minimally invasive method after a shrapnel wound to the neck: a case report

This case report describes the diagnosis and surgical management of a shrapnel wound to the neck with a retained foreign body (metal fragment) in the anterior mediastinum. A 44-year-old male service member was wounded in the neck during an air raid. Thirty minutes after sustaining the injury, the patient reached a forward surgical team, exhibiting hemodynamic instability responsive to resuscitation. After initial stabilization, the forward team performed primary surgical treatment of the wound, including hemostasis, irrigation and debridement, and drainage. Twelve hours later, the patient was transported by ground to the Military Medical Clinical Center of the Northern Region of the Military Medical Center of the Armed Forces of Ukraine and hospitalized in the surgical department. Diagnostic evaluation included computed tomography of the head, chest, abdomen, and pelvis along with esophagogastroduodenoscopy, which demonstrated fracture of left ribs 1 and 2, a 40×15-mm metal fragment in the anterior superior mediastinum with pneumomediastinum and hemomediastinum, and metal fragments in the soft tissues of the neck without contrast extravasation. Esophagogastroduodenoscopy revealed no evidence of esophageal injury. Surgical management included left video-assisted thoracoscopic surgery with opening of the anterior mediastinum and removal of the foreign body (metal shrapnel fragment) using a magnetic surgical instrument. The patient was discharged 2 weeks postoperatively. Gunshot wounds of the neck with a large foreign body in the anterior mediastinum are rare. The use of minimally invasive surgical techniques and modern magnetic surgical instruments can reduce surgical morbidity and may be used at tertiary care centers.