Cervical gunshot injury with esophageal perforation and bullet migration to the stomach: a rare case report

Background: Penetrating neck injuries (PNIs) are uncommon but are associated with considerable morbidity and mortality, with reported rates approaching 10% due to the concentration of vital structures in the cervical region. Esophageal injuries – often initially missed – are a major contributor to delayed mortality. Prompt assessment of the airway, hemodynamic stability, and associated injuries is essential. Here, we report a rare case of a previously healthy patient who sustained a PNI with a subsequent delayed presentation of esophageal perforation. Case presentation: A 17-year-old male presented 3 hours after sustaining a Zone II gunshot wound to the right side of the neck. He was hemodynamically stable, and initial imaging showed no abnormalities. Twelve hours later, the development of fever prompted further evaluation with abdominal computed tomography (CT), which revealed the projectile in the stomach, suggesting migration through the esophagus. Discussion: Even hemodynamically stable patients with PNIs may develop delayed complications, including esophageal perforation and bullet migration, which can be missed during the initial assessment. Recognition of evolving symptoms, early repeat imaging, and timely surgical intervention are essential in achieving favorable outcomes. Conclusion: PNIs require vigilant monitoring and a structured, guideline-based diagnostic approach to avoid missed aerodigestive injuries. To our knowledge, this is the first reported case of a cervical gunshot projectile migrating into the stomach through the esophagus.