釘8本による頭部穿通外傷の1治験例

Multiple Penetrating Head Injury by 8 Nails: A Case Report

Ⅰ．はじめに

　釘1本による頭部穿通外傷は事故によりときに遭遇するが，複数釘の報告は少ない．今回われわれは自殺企図に8本の釘を自動釘打ち機で打ち込んだ症例を経験したため，その受傷機転，治療法も含め文献的考察を加えて報告する．

　A case report of penetrating head injury due to 8 nails and a review of multiple penetrating head injury by nails were described. The patient who was a 48-year-old man with a history of for psychiatric care was transferred to our emergency room on May 2007. He had shot his head with 8 nails using a nail-gun in a suicide attempt. His family called an ambulance. His conscious level was 1 on the Japan Coma Scale and 15 on the Glasgow Coma Scale with monoplegia of the right lower extremity and hypoesthesia of the right extremities. X-ray films of his head revealed 8 nails penetrating his cranium. The CT scan showed thin hematoma on the right convexity. Angiography didn’t demonstrate any evidence of vascular injury. Under general anesthesia, all nails were removed after craniotomy. His post-operative course was good and he was discharged home with minimal deficits.

　Penetrating head injury with nail-gun use is sometimes seen, but cases with multiple nails are rare. Operative strategies were discussed in the review. It also suggested the need for the care of mental or background problems.