Experience with removal of foreign bodies from the lungs, pleura and mediastinum in patients with penetrating gunshot wounds of the chest
D. A. Yasyuchenya,
I. V. Dmitrochenko,
I. I. Dzidzava,
A. M. Mashchenko,
E. E. Fufaev,
V. A. Popov,
V. M. Nechiporuk,
O. V. Barinov,
B. N. Kotiv https://doi.org/10.24884/0042-4625-2025-184-6-54-63
Abstract
The OBJECTIVE was to evaluate the effectiveness of modern surgical methods for removing intrathoracic foreign bodies in patients with penetrating gunshot chest wounds.
METHODS AND MATERIALS. The study included 207 patients with intrathoracic foreign bodies (FBs) after penetrating gunshot chest wounds. Depending on the size and location of the FBs, the choice of surgical access and method of their removal was determined.
RESULTS. FBs were large in 35 (17 %), medium – in 113 (54.6 %), small – in 59 (28.4 %) patients. Localization of FBs was noted in: lung parenchyma – 76 (36.7 %), mediastinum – 28 (13.5 %), pleural cavity – 103 (49.7 %) patients. In 197 (95.2 %) cases, the FBs were removed using videothoracoscopic methods, «open» surgical procedures were undertaken only in 3.4 % (n=7) of observations, and intraluminal endoscopic interventions were performed in 3 (1.4 %) cases. Postoperative complications developed in 14 (6.7 %) patients. There were no fatal outcomes.
CONCLUSION. In specialized thoracic surgery departments, minimally invasive video-assisted thoracoscopic surgical procedures are used in most cases to remove FBs from the pleura, lungs and mediastinum. Indications for performing thoracotomy and sternotomy are limited to cases of removing FBs from dangerous locations (heart, main vessels).
About the Authors
D. A. Yasyuchenya
Military Medical Academy
Russian Federation
Competing Interests:
Russian Federation
Yasyuchenya Denis A., Cand. of Sci. (Med.), Lieutenant Colonel of the Medical Service, Senior Lecturer of the Department of Hospital Surgery
6, Academica Lebedeva str., Saint Petersburg, 194044
Competing Interests:
The authors declare no conflict of interest.
I. V. Dmitrochenko
Military Medical Academy
Russian Federation
Competing Interests:
Russian Federation
Dmitrochenko Ivan V., Cand. of Sci. (Med.), Major of the Medical Service, Senior Resident of the Surgical Department of the Clinic of the Department of Hospital Surgery
6, Academica Lebedeva str., Saint Petersburg, 194044
Competing Interests:
The authors declare no conflict of interest.
I. I. Dzidzava
Military Medical Academy
Russian Federation
Competing Interests:
Russian Federation
Dzidzava Ilya I., Dr. of Sci. (Med.), Associate Professor, Colonel of the Medical Service, Head of the Department of Hospital Surgery
6, Academica Lebedeva str., Saint Petersburg, 194044
Competing Interests:
The authors declare no conflict of interest.
A. M. Mashchenko
North-Western District Research Clinical Center named after L. G. Sokolov
Russian Federation
Competing Interests:
Russian Federation
Mashchenko Anastasiya M., Thoracic Surgeon of the Department of Thoracic Surgery
6, Academica Lebedeva str., Saint Petersburg, 194044
Competing Interests:
The authors declare no conflict of interest.
E. E. Fufaev
Military Medical Academy
Russian Federation
Competing Interests:
Russian Federation
Fufaev Evgeniy E., Cand. of Sci. (Med.), Colonel of the Medical Service, Deputy Head of the Department of Hospital Surgery
6, Academica Lebedeva str., Saint Petersburg, 194044
Competing Interests:
The authors declare no conflict of interest.
V. A. Popov
Military Medical Academy
Russian Federation
Competing Interests:
Russian Federation
Popov Vladimir A., Cand. of Sci. (Med.), Lieutenant Colonel of the Medical Service, Head of the Surgical Department of the Clinic of the Department of Hospital Surgery
6, Academica Lebedeva str., Saint Petersburg, 194044
Competing Interests:
The authors declare no conflict of interest.
V. M. Nechiporuk
Military Medical Academy
Russian Federation
Competing Interests:
Russian Federation
Nechiporuk Vasily M., Thoracic Surgeon of the Thoracic Surgical Department of the Clinic of the Department of Hospital Surgery
6, Academica Lebedeva str., Saint Petersburg, 194044
Competing Interests:
The authors declare no conflict of interest.
O. V. Barinov
Military Medical Academy
Russian Federation
Competing Interests:
Russian Federation
Barinov Oleg V., Dr. of Sci. (Med.), Associate Professor, Colonel of the Medical Service, Professor of the Department of Hospital Surgery
6, Academica Lebedeva str., Saint Petersburg, 194044
Competing Interests:
The authors declare no conflict of interest.
B. N. Kotiv
Military Medical Academy
Russian Federation
Competing Interests:
Russian Federation
Kotiv Bogdan N., Dr. of Sci. (Med.), Professor, Deputy Head of the Academy for Clinical Work
6, Academica Lebedeva str., Saint Petersburg, 194044
Competing Interests:
The authors declare no conflict of interest.
References
1. Trishkin D. V., Kryukov Ye. V., Chuprina A. P. et al. Metodicheskiye rekomendatsii po lecheniyu boyevoy khirurgicheskoy travmy. Ministerstvo oborony Rossiyskoy Federatsii / Gl. voyen.-med. upr. Minoborony Rossii. Moscow Publ. 2022. 373 p. (In Russ.).
2. Samokhvalov I. M., Badalov V. I., Tynyankin N. A. et al. VoyennoPolevaya Khirurgiya = Military Field Surgery. Textbook. Ed. Samokhvalov I. M. St. Petersburg Publ. 2021. 494 p. (In Russ.).
3. Khorram-Manesh A., Goniewicz K., Burkle F. M., Robinson Y. Review of Military Casualties in Modern Conflicts-The Re-emergence of Casualties From Armored Warfare. Military medicine. 2022;187(3–4):313–321. https://doi.org/10.1093/milmed/usab108.
4. Trukhan A. P. Ognestrel’nyye raneniya i vzryvnaya travma mirnogo vremeni. Osobennosti, organizatsiya i okazaniye khirurgicheskoy pomoshchi (kliniko-eksperimental’noye issledovaniye): dis. … dokt. med. nauk: 31.90.00. VMedA. SPb. 2022. 258 p. (In Russ.).
5. Hoencamp R., Idenburg F. J., Hamming J. F., Tan E. C. Incidence and epidemiology of casualties treated at the Dutch role 2 enhanced medical treatment facility at multinational base Tarin Kowt, Afghanistan in the period 2006-2010. World J. Surg. 2014;38(7):1713–1718. https://doi.org/10.1007/s00268-014-2462-x.
6. Hoencamp R., Vermetten E., Tan E. C., Putter H. et al. Systematic review of the prevalence and characteristics of battle casualties from NATO coalition forces in Iraq and Afghanistan. Injury. 2014;45(7):1028–1034. https://doi.org/10.1016/j.injury.2014.02.012.
7. Belmont P. J. Jr, McCriskin B. J., Sieg R. N. et al. Combat wounds in Iraq and Afghanistan from 2005 to 2009. J. Trauma Acute Care Surg. 2012;73(1):3–12. https://doi.org/10.1097/TA.0b013e318250bfb4.
8. Kolesnikov I. S. Udaleniye inorodnykh tel iz plevral’noy polosti, legkikh i sredosteniya / pod red. P. A. Kupriyanova. Moskva: Izd-vo Akad. med. nauk USSR. 1949. 252 p. (In Russ.).
9. Giannou C., Baldan M. War Surgery: Working with Limited Resources in Armed Conflict and Other Situations of Violence: reference book: in two volumes. Vol. 1. Moscow: МККК, 2010. 199 p. (In Russ.).
10. Bisenkov L. N., Bebiya N. V., Grishakov S. V. et al. Torakal’naya khirurgiya: Rukovodstvo dlya vrachey / pod red. zasl. deyat. nauki RF prof. L. N. Bisenkova. SPb., Elbi-SPb, 2004. 927 p. (In Russ.).
11. Kolesnikov I. S. Udaleniye inorodnykh tel iz plevral’noy polosti, plevral’nykh srashcheniy i shvartov, iz legkikh i sredosteniya: dis. … dokt. med. nauk: [v 2-kh ch.]: prilozheniye v 2 chastyakh. VMedA. L., 1946. (In Russ.).
12. Khalifa M., Abu-Zidan F. M., Khan N., Black E. Removal of cardiothoracic war-related shrapnel using video-assisted thoracoscopic surgery. Ulus Travma Acil Cerrahi Derg. 2017;(4):348–350. https://doi.org/10.5505/tjtes.2016.67378.
13. Petricevic A., Ilic N., Bacic A., Petricevic M. et al. War injuries of the lungs. Eur J Cardiothorac Surg. 1997;11(5):843–8477. https://doi.org/10.1016/s1010-7940(97)01163-9.
14. Sersar S. I., Albohiri K. A., Abdelmohty H. Impacted thoracic foreign bodies after penetrating chest trauma. Asian Cardiovasc Thorac Ann. 2016;24(8):782–787. https://doiorg/10.1177/0218492316664673.
15. Swiech A., Boddaert G., Daban J. L., Falzone E. et al. Penetrating thoracic injuries: a retrospective analysis from a French military trauma centre. BMJ Mil Health. 2021;167(1):33–39. https://doi.org/10.1136/jramc-2019-001159.
16. Behbehani A., Abu-Zidan F., Hasaniya N., Merei J. War injuries during the Gulf War: experience of a teaching hospital in Kuwait. Ann R Coll Surg Engl. 1994;(76):407–411.
17. Borgaonkar V., Borgaonkar V. Thoracoscopic retrieval of intra-parenchyamal foreign body of lung. Indian J Surg. 2010;72(3):252–252. https://doi.org/10.1007/s12262-010-0063-y.
18. Raneniya grudi / Opyt sovetskoy meditsiny v Velikoy Otechestvennoy voyne 1941-1945 gg.: v. 35 t.. Medgiz, 1949-1955. T. 9, ch. 1. 1950. 530 p. (In Russ.).
19. Pirogov N. I. Nachala obshchey voyenno-polevoy khirurgii / Sobraniye sochineniy v desyati tomakh. Tom VI. Chast’ 1. Moskva: Istorikoliteraturnyy zhurnal «Strannik”». 2022. 588 p. (In Russ.).
20. Dzhanelidze Yu. Yu. Inorodnyye tela legkikh i plevry ognestrel’nogo proiskhozhdeniya. Vestnik khirurgii im. I. I. Grekova. 1943;63(3–4):11–21. (In Russ.).
21. Moynihan B. The surgery of the chest in relation to retained projectiles. British Journal of Surgery. 1919;7(28):444–486. https://doi.org/10.1002/bjs.1800072804.
22. Bryusov P. G., Kuritsyn A. N., Urazovskiy N. Yu. Operativnaya videotorakoskopiya v okazanii neotlozhnoy khirurgicheskoy pomoshchi pri ognestrel’nykh pronikayushchikh raneniyakh grudi. Voyennomeditsinskiy zhurnal. 1998;319(2):21–26. (In Russ.).
23. Chuprina A. P., Kucherenko A. D., Fokin A. V. Inorodnyye tela legkikh i plevry posle raneniy grudi: naslediye akademika I. S. Kolesnikova. Vestnik Natsional’nogo mediko-khirurgicheskogo tsentra im. N. I. Pirogova. 2018;13(1):37–41. (In Russ.).
24. Voyenno-polevaya khirurgiya. Uchebnik. Vtoroye izdaniye, pererabotannoye i dopolnennoye / Ye. K. Gumanenko, eds. Geotar-media. 2022. 768 p. (In Russ.).
25. Bryusov P. G., Urazovskiy N. Yu. Okazaniye neotlozhnoy khirurgicheskoy pomoshchi pri ognestrel’nykh pronikayushchikh raneniyakh grudi. Voyenno-meditsinskiy zhurnal. 2001;(2):29–39. (In Russ.).
26. Sergoventsev A. A., Datsko A. V., Kotiv B. N. et al. Inorodnyye tela posle raneniy i travm. Vremennyye ukazaniya po lecheniyu i voyennovrachebnoy ekspertize / GVMU MO RF. 2023. 60 p. (In Russ.).
27. Kolesnikov I.S. Rukovodstvo po legochnoy khirurgii / pod red. prof. I.S. Kolesnikova. Leningrad: Meditsina. 1969. 680 s. (In Russ.).
28. Lurin I., Khoroshun E., Negoduiko V. et al. Retrieval of ferromagnetic fragments from the lung using video-assisted thoracoscopic surgery and magnetic tool: a case report of combat patient injured in the war in Ukraine. Int J Emerg Med. 2023;16(1):51. https://doi.org/10.1186/s12245-023-00527-8.
29. Kakamad F. H., Ali R. K., Mohammed S. H. et al. Single port videoassisted thoracoscopic surgery for removal of a retained bullet in the lung parenchyma; A case report with literature review. Annals of medicine and surgery. 2021;71:102977. https://doi.org/10.1016/j.amsu.2021.10297.
30. Essa R. A., Ahmed S. K. Uniportal video-assisted thoracoscopic surgery for retained shrapnel in the thoracic cavity: An update surgical approach for removal of foreign body. Annals of medicine and surgery. 2022;75:103402. https://doi.org/10.1016/j.amsu.2022.103402.
31. Shvedyuk V. V., Yelin N. Ye., Dzidzava I. I. et al. Opyt primeneniya neodimovykh magnitnykh instrumentov dlya udaleniya inorodnykh tel pri slepykh raneniyakh. Izvestiya Rossiyskoy Voyenno-meditsinskoy akademii. 2023;42(2):105–114. https://doi.org/10.17816/rmmar346674. (In Russ.).
32. Fufaev E. E., Dmitrochenko I. V., Dzidzava I. I. et al. Sposob identifikatsii, fiksatsii i udaleniya ferromagnitnykh inorodnykh tel pri ognestrel’nykh pronikayushchikh raneniyakh grudi / Patent na izobreteniye. № 2825952 ot 29.09.2023 g.: opubl. 02.09.2024 g. Byul. № 25. URL: https://www.elibrary.ru/item.asp?id=69737784 (accessed: 01.12.25). (In Russ.).
33. Manukovskiy V. A., Tulupov A. N. Ognestrel’nyye raneniya grudi, zhivota, taza i pozvonochnika: rukovodstvo dlya vrachey. Moskva, GEOTARMedia, 2022. 238 p. (In Russ.). https://doi.org/10.33029/9704-6558-5-CPS-2022-1-240.
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For citations:
Yasyuchenya D.A., Dmitrochenko I.V., Dzidzava I.I., Mashchenko A.M., Fufaev E.E., Popov V.A., Nechiporuk V.M., Barinov O.V., Kotiv B.N. Experience with removal of foreign bodies from the lungs, pleura and mediastinum in patients with penetrating gunshot wounds of the chest. Grekov's Bulletin of Surgery. 2025;184(6):54-63. (In Russ.) https://doi.org/10.24884/0042-4625-2025-184-6-54-63
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