Delayed Surgical Intervention for a Self-Inflicted Left Chest Injury From a Nail Gun: Addressing 28 Nails Six Months...

Area of Science:

• Thoracic surgery
• Trauma surgery
• Case reports

Background:

• Firearms are the most common method in over 1.7 million US suicide attempts annually.
• Nail gun injuries, though less common, present unique challenges in foreign body removal.
• Delayed presentation of symptoms like hemoptysis can complicate initial management strategies.

Observation:

• A case of a nail gun suicide attempt involving the left hemithorax is reported.
• Initial conservative management was complicated by delayed hemoptysis, necessitating surgical intervention.
• Robotic-assisted surgery was attempted but required conversion to open thoracotomy due to dense adhesions.

Findings:

• Twenty-eight nails were successfully removed from the left hemithorax.
• Foreign body migration is hypothesized as the cause of delayed presentation.
• The patient experienced an uncomplicated post-operative course.

Implications:

• This case highlights the importance of considering delayed complications in penetrating thoracic injuries.
• Surgical intervention may be required despite initial conservative management.
• Foreign body migration can significantly impact the timing and approach to surgical removal.