A road trip to Mexico for cosmetic surgery ended with two Americans dead — and two others found alive — after a violent shootout and kidnapping, officials said.

The surviving Americans are back on US soil after being sped to the border near Brownsville, the southernmost tip of Texas, in a convoy of ambulances and cars escorted by Mexican military Humvees and National Guard trucks with mounted machine guns.

A relative of one of the victims said on Monday that the four had travelled together from the Carolinas so one of them could get a tummy tuck from a doctor in the Mexican border city of Matamoros, where Friday’s kidnapping took place.

Tamaulipas governor Americo Villarreal said the four were found in a wooden hut, where they were being guarded by a man who has been arrested.

Mr Villarreal said the Americans were moved around by their captors and at one point were taken to a medical clinic “to create confusion and avoid efforts to rescue them”.

The two dead will be turned over to US authorities after forensic work at the Matamoros morgue in the coming hours, the governor said.

Mr Villareal said the wounded American, Eric Williams, had been shot in the left leg and the wound was not life threatening. The survivors were taken to Valley Regional Medical Centre with an FBI escort, the Brownsville Herald reported. A hospital spokesman referred all inquiries to the FBI.

The US citizens were found in a rural area called Ejido Tecolote, east of Matamoros, on the way to the Gulf coast known as Bagdad Beach, according to Tamaulipas state chief prosecutor Irving Barrios.

Shortly after entering Mexico on Friday, the four were caught up in fighting between rival cartel groups in the city. Mr Barrios said the hypothesis is “that it was confusion, not a direct attack”.

Video and photographs taken during and immediately after the abduction show the Americans’ white minivan sitting beside another vehicle, with at least one bullet hole in the driver’s side window. A witness said the two vehicles had collided. Almost immediately, several men in tactical vests and toting assault rifles arrived in another vehicle to surround the scene.

The gunmen walked one of the Americans into the bed of a white pickup, then dragged and loaded the three others. Terrified civilian motorists sat silently in their cars, hoping not to draw their attention. Two of the victims appeared to be motionless.

Officials said a Mexican woman a block and a half away from the scene also died in Friday’s crossfire.

The shootings illustrate the terror that has prevailed for years in Matamoros, a city dominated by factions of the powerful Gulf drug cartel who often fight among themselves. Amid the violence, thousands of Mexicans have disappeared in Tamaulipas state alone.

Robert Williams said his brother, 38-year-old Eric Williams, was among those kidnapped. The brothers are from South Carolina but live in the Winston-Salem area of North Carolina, he said.

Mr Williams described his brother as “easygoing” and “fun-spirited”.

He did not know his brother was travelling to Mexico until after the abduction hit the news. But from looking at his brother’s Facebook posts, he thinks his brother did not consider the trip dangerous.

“He thought it would be fun,” Mr Williams said. He had not heard anything about his brother’s whereabouts, he said.

Mexican President Andres Manuel Lopez Obrador said the people responsible will be punished. He referenced arrests made in the 2019 killings of nine US-Mexican dual citizens in Sonora near the US border.

He complained about the US media’s coverage of the missing Americans, accusing them of sensationalism. “It’s not like that when they kill Mexicans in the United States, they (the media) go quiet like mummies,” he said.

“It’s very unfortunate, they (the US government) have the right to protest like they have,” Mr Lopez Obrador said.

“We really regret that this happens in our country.”

US attorney general Merrick Garland said: “The cartels are responsible for the deaths of Americans.”

He added: “The DEA and the FBI are doing everything possible to dismantle and disrupt and ultimately prosecute the leaders of the cartels and the entire networks that they depend on.”

White House National Security Council spokesman John Kirby said the US is working with Mexican officials to learn more about the circumstances surrounding the killings.

The FBI had offered a 50,000 US dollar (£42,242.50) reward for the victims’ return and the arrest of the kidnappers.