Emergency open repair of war-related traumatic carotid artery injury caused by shrapnel in a resource-limited setting.

Penetrating carotid artery injuries are rare but life-threatening, particularly in resource-limited and conflict settings. We report a case of a 23-year-old male presenting with hypovolemic shock, respiratory arrest, and active neck hemorrhage secondary to a shrapnel injury. Emergency open exploration and primary repair of the carotid artery were performed in a field hospital without access to anesthesiology support, advanced imaging, or intensive care facilities. The patient survived without neurological deficit and was discharged on postoperative day 14. This case highlights the feasibility of life-saving vascular repair in austere environments using fundamental surgical principles.