内頸動脈内散弾異物症例

A Bullet Foreign Body Migrating in the Cerebral Circulation

　はじめに

　本邦での銃創の症例は欧米に比べるとはるかにその数は少ない。最近われわれは，狩猟中に散弾銃にて誤射され，全身に被弾した症例の，第一頸椎前部の留弾を口腔内より摘出操作中に，動脈壁内に留っていたと思われた散弾が脳血管内へ迷入した症例を経験したので報告する。

A 57-year-old man was admitted to the hos-pital following a shotgun injury. X-ray examina-tion showed eighteen pellets over the entire body including the maxillary sinus and the anteriorpart of atlas. Surgical removal of pellets was performed under general anesthesia, but a pellet adjacent to the atlas was migrated into the cer-bral circulation during the transoral approach under fluoroscopy. Emergency carotid angiogra-phy revealed an occulusion of the right middle cerebral artery. After craniotomy, the pellet was removed from the vascular lumen of the M2 segment.