Topographic anatomy and intraoperative USG-guided foreign bodies extraction of neglected Molotov cocktail victim: A rare case report

Introduction and significance: Foreign body implantation resulting from explosive devices is an extraordinary occurrence that often leads to substantial morbidity among the affected individuals. Explosions caused by such devices generate a rapidly propagating blast wave emanating from the point of detonation. This study aims to present a case involving a patient who experienced multiple foreign body implantations as a consequence of a bomb explosion. Case presentation: A 41-year-old male presented with a history of multiple foreign bodies retained within his body for the past 22 years, originating from a homemade explosive device. At present, he reports weakness in his lower extremities, numbness extending from the umbilical region down to the lower extremities, and fecal incontinence. The patient underwent a surgical procedure for the removal of these foreign bodies, guided by ultrasonography (USG), which lasted for a duration of 12 h. Clinical discussion: The presence of foreign bodies within the human body incites an inflammatory response. In preparation for surgery, topographic anatomy is delineated through the use of pre-operative CT scans to ascertain the precise locations of these foreign bodies. Subsequently, the removal of these foreign bodies is executed under the guidance of ultrasound. Conclusion: The extraction of multiple foreign bodies from a patient's body is an infrequent surgical procedure. Meticulous surgical planning, aided by the utilization of X-rays and CT scans for topographic anatomical mapping, is imperative. Employing real-time ultrasound guidance during the procedure serves to minimize blood loss and mitigate potential damage to adjacent structures, thereby enhancing patient safety and reducing the likelihood of surgical complications.