Multidisciplinary long-term primary care surveillance of a retained abdominal metallic fragment with potential lead exposure: a case report

Background. Armed conflicts have led to an increasing number of patients with retained metallic fragments, the surgical removal of which is often contraindicated due to high operative risks. These fragments may serve as a source of chronic lead exposure even in the absence of clinical symptoms, necessitating long-term medical surveillance. The role of primary care in coordinating such monitoring remains insufficiently explored. The purpose was to highlight the critical role of primary care in coordinating long-term monitoring in post-conflict patients who live with retained metallic fragments. Materials and methods. Due to the fragment’s high-risk anatomical location and the substantial potential for hemorrhagic and visceral complications, surgical removal was deemed contraindicated, and a conservative management strategy coordinated by a family physician was implemented, including periodic imaging surveillance to assess fragment stability and scheduled blood lead level (BLL) monitoring. Results. A structured active surveillance strategy was implemented. This included periodic imaging to assess fragment stability and annual BLL testing. The BLL was 2.2 µg/dL, remaining within the reference range (≤ 8.5 µg/dL) according to the private laboratory’s reference values. Conclusions. Retained fragments should be recognized as a potential source of chronic lead exposure, warranting proactive monitoring even in asymptomatic individuals. In post-conflict settings, primary care physicians play a pivotal role in ensuring continuity of care for patients with retained metallic fragments after acute surgical decision-making has concluded. Structured surveillance led by primary care may therefore represent a critical component of sustainable health system responses to armed conflict, particularly in countries facing large populations of veterans and former prisoners of war.