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Table of Contents
Year : 2020  |  Volume : 10  |  Issue : 4  |  Page : 213-215

Use of video-assisted thoracoscopy surgery in the removal of an intrathoracic bullet: A case report

Department of Pediatric Surgery, Faculty of Medicine, Harran University, Sanliurfa, Turkey

Date of Submission01-Apr-2019
Date of Acceptance29-Sep-2020
Date of Web Publication29-Dec-2020

Correspondence Address:
Dr. Mustafa Erman Dorterler
Department of Pediatric Surgery, Faculty of Medicine, Harran University, Sanliurfa
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJCIIS.IJCIIS_27_19

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The use of video-assisted thoracoscopy surgery (VATS) as a minimally invasive surgical technique in many lung and pleural diseases is well-established. However, the efficacy of VATS in the removal of retained intrathoracic foreign bodies is unclear. Here, we report the use of VATS in the successful removal of an intrathoracic bullet from a 7-year-old patient.

Keywords: Bullet, child, thoracoscopy

How to cite this article:
Dorterler ME, Cakmak M, Gunendi T, Kocaman OH, Boleken ME. Use of video-assisted thoracoscopy surgery in the removal of an intrathoracic bullet: A case report. Int J Crit Illn Inj Sci 2020;10:213-5

How to cite this URL:
Dorterler ME, Cakmak M, Gunendi T, Kocaman OH, Boleken ME. Use of video-assisted thoracoscopy surgery in the removal of an intrathoracic bullet: A case report. Int J Crit Illn Inj Sci [serial online] 2020 [cited 2023 Mar 30];10:213-5. Available from: https://www.ijciis.org/text.asp?2020/10/4/213/305298

   Introduction Top

Video-assisted thoracoscopy surgery (VATS) is a minimally invasive surgical technique with a well-established role in trauma patients, including the assessment of penetrating injuries in the diaphragm and the treatment of hemothorax, empyema, and persistent pneumothorax.[1],[2],[3] However, despite its potential as an alternative to extensive thoracotomy[4] and its ability to remove retained foreign bodies, including bullets, from the thoracic/pleural cavity, the literature contains few reports on the use of VATS in these settings.[1],[2],[5],[6],[7] Here, we describe the use of VATS in the removal of a bullet located in the thoracic cavity of a 7-year-old girl.

   Case Report Top

A 7-year-old girl was referred to our hospital on the identification of a suspected foreign body (bullet entry) on a posteroanterior chest X-ray obtained during her initial admission to another hospital. A wound in her neck had been recognized by her parents after she returned home from playing in the garden of their house. At our hospital, her examination revealed a good general condition, and she was conscious, with stable vital signs. A penetrating injury on the left lateral side of the neck appeared to be a gunshot entry wound [Figure 1], confirmed by visualization of the bullet in the thoracic cavity on further radioimaging, including trans-cervical and transthoracic radiography and multidetector computed tomography [Figure 2] and [Figure 3]. The bullet had exited the lung parenchyma at the basal right lower lobe. The diagnosis was a bullet free in the thoracic cavity and removal through VATS was indicated. Under general anesthesia, the patient was placed in the left lateral decubitus position and intubated with a double-lumen endotracheal tube. A 10-mm trocar and two 5-mm trocars were introduced, and the bullet was easily removed with the aid of a forceps.
Figure 1: Neck left lateral bullet entry hole

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Figure 2: X-ray images of the bullet, Trans-cervical and transthoracic radiography and multidetector computed tomography images

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Figure 3: Image of the intrathoracic bullet

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The chest tube was left in place for 48 h, and the patient was discharged from the hospital on postoperative day 3. No problems were detected within the 6-month postoperative follow-up period.

   Discussion Top

This case of a 7-year-old accidental gun-shot victim demonstrates the efficacy and safety of VATS in the removal of an intrathoracic bullet. Further advantages were the short hospital stay, the absence of operative or early postoperative complications, and no long-term complications during the 6-month follow-up.

Successful outcomes following the use of VATS in the removal of foreign bodies from the thoracic cavity have been reported.[2],[7],[8],[9] Those cases included a Kirschner wire, a bullet, and a grenade fragment located in the pleural cavity, a bullet located in the pericardial sac,[10] glass fragments in the pleural cavity,[4] bullets from the pleural cavity,[2] iatrogenic material or sharp objects in the thoracal cavity,[1],[7],[8],[9],[11],[12],[13] and a bullet in the pericardial cavity.[6]

Our study, together with those previous reports, establish VATS as a safe and less invasive method allowing the removal of a foreign body from the pleural cavity under direct viewing.[8] Consistent with the faster and favorable complication-free recovery seen in our patient, VATS offers an alternative to extensive thoracotomy.[4] Other reports have additionally determined a lower risk of complications, milder postoperative pain, shorter chest tube duration time, shortened length of hospitalization, reduced hospital costs, and an earlier return to work.[1],[2],[8],[14],[15]

Despite its current, relatively minimal role in acute trauma care, the widespread use VATS in trauma patients can be expected, accompanied by clearer indications and standardized protocols. The increased popularity of minimal access surgery, continued technological improvements, and the increased training and experience of trauma surgeons will also contribute to the greater adoption of VATS.[1],[16],[17]

In conclusion, our findings support the use of VATS as an easy, simple, and practically risk-free minimal invasive method allowing the early removal of an intrathoracic foreign body and a favorable long-term outcome in hemodynamically stable pediatric patients.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

Ethical conduct of research statement

This case report did not require approval by the Institutional Review Board / Ethics Committee. The authors followed applicable EQUATOR Network (http://www.equator-network.org/) guidelines, specifically the CARE guideline, during the conduct of this research project.

   References Top

Radjou AN, Uthrapathy M. Video-assisted thoracoscopy in trauma: Case report and review of literature. Lung India 2011;28:142-4.  Back to cited text no. 1
[PUBMED]  [Full text]  
Marsico GA, Almeida AL, Azevedo DE, Venturini GC, Azevedo AE, Marsico Pdos S. Video-assisted thoracoscopic removal of foreign bodies from the pleural cavity. J Bras Pneumol 2008;34:241-4.  Back to cited text no. 2
Khalifa M, Abu-Zidan FM, Khan N, Black E. Removal of cardiothoracic war-related shrapnel using video-assisted thoracoscopic surgery. Ulus Travma Acil Cerrahi Derg 2017;23:348-50.  Back to cited text no. 3
Bartek JP, Grasch A, Hazelrigg SR. Thoracoscopic retrieval of foreign bodies after penetrating chest trauma. Ann Thorac Surg 1997;63:1783-5.  Back to cited text no. 4
Stafman LL, Gutwein LG, Ang DN. Use of video-assisted thoracoscopic surgery in penetrating chest trauma. J Thorac Cardiovasc Surg 2013;146:979.  Back to cited text no. 5
Khalil MW, Khan T, Gower S, Loubani M. Removal of a bullet in the pericardial cavity by video-assisted thoracoscopic surgery. Interact Cardiovasc Thorac Surg 2012;15:297-8.  Back to cited text no. 6
Yazgan S, Yoldaş B, Gürsoy S. Video-assisted thoracoscopic removal of a mysterious foreign body causing pneumothorax. Respir Case Rep. 2018;7:75-8.  Back to cited text no. 7
Williams CG, Haut ER, Ouyang H, Riall TS, Makary M, Efron DT, et al. Video-assisted thoracic surgery removal of foreign bodies after penetrating chest trauma. J Am Coll Surg 2006;202:848-52.  Back to cited text no. 8
Jutley RS, Cooper G, Rocco G. Extending video-assisted thoracoscopic surgery for trauma: The uniportal approach. J Thorac Cardiovasc Surg 2006;131:1424.  Back to cited text no. 9
Lang-Lazdunski L, Mouroux J, Pons F, Grosdidier G, Martinod E, Elkaïm D, et al. Role of videothoracoscopy in chest trauma. Ann Thorac Surg 1997;63:327-33.  Back to cited text no. 10
Boulanger B, Lahmann B, Ochoa J. Minimally invasive retrieval of a foreign body after penetrating lung injury. Surg Endosc 2001;15:1043.  Back to cited text no. 11
Mironenko ON, Koveshnikov AV, Glushchenko RN. Videothoracoscopic removal of the foreign body from the left pleural cavity. Klin Khir 2003; 62.  Back to cited text no. 12
Dinka T, Kovács O, Kotsis L. Emergency video-assisted thoracoscopic surgery for intrathoracic foreign bodies. Magy Seb 2004;57:346-50.  Back to cited text no. 13
Whitson BA, Andrade RS, Boettcher A, Bardales R, Kratzke RA, Dahlberg PS, et al. Video-assisted thoracoscopic surgery is more favorable than thoracotomy for resection of clinical stage I non-small cell lung cancer. Ann Thorac Surg 2007;83:1965-70.  Back to cited text no. 14
Ben-Nun A, Orlovsky M, Best LA. Video-assisted thoracoscopic surgery in the treatment of chest trauma: Long-term benefit. Ann Thorac Surg 2007;83:383-7.  Back to cited text no. 15
Milanchi S, Makey I, McKenna R, Margulies DR. Video-assisted thoracoscopic surgery in the management of penetrating and blunt thoracic trauma. J Minim Access Surg 2009;5:63-6.  Back to cited text no. 16
Degiannis E, Bowley DM, Smith MD. Minimally invasive surgery in trauma: Technology looking for an application. Injury 2004;35:474-8.  Back to cited text no. 17


  [Figure 1], [Figure 2], [Figure 3]


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