An Atypical Location of a Projectile in Sacrum about a Case

Abstract

Introduction: Since 1990, several investigators have reported an increase in the incidence of spinal cord injuries, with penetrating trauma being the leading cause of spinal cord injury in some urban trauma centers [1]. We report a case with an inlet at L4-L5 and a final migration at S1. Observation: Trader of 28 years, received January 21, 2016 for low back pain and desire to remove a projectile at the level of the spine. The loco-regional examination found a scar of the orifice in projection of the fourth and fifth lumbar vertebra. The radiological assessment carried out showed: on radiography the projectile at the sacral level; And to the computed tomography, an oval hyper dense formation of size 31x15x10 mm extended from the first sacral vertebra to the second sacral vertebra in relation to the evoked ball with a solution of continuity of the right blade facing it. At the exploration, one noticed the ball buried in the sacral channel pushing back the nerve elements in posterior and with a prominence of a radicular section to the right, and a fracture of the blade to the right. Discussion: Spinal lesions by firearm are increasingly common. Kuijen et al. [2] were able to identify four cases of bullets left in place with delayed neurological symptoms. However, these bullets remained localized in epidural as in our patient. The only discrepancy is that the symptomatology was early in our clinical case with a motor unilateral motor deficit secondary to an axonal lesion. The decision to leave or remove a fragment lodged in the spinal canal depends on several factors. Given its composition in copper and lead, the risk of further development of neurological complications was evident. He also had other neurological complications, not related to the toxicity of the different components of the projectile, but to its presence in the sacral canal. And this is all the more increased by the narrowness of this channel and by the rather large number of mesh roots found there. Conclusion: In addition, imaging plays an important role in the initial management of patients with hemo- dynamically stable bales regardless of the location of the projectile. CT is very useful to objectify the trajectory of the ball and to make a precise lesional balance thus making it possible to provide valuable information for the management of this condition.