Thoracic impalement injury: A survivor with large metallic object in-situ

A non-lethal left sided thoracic impalement injury: A case report

INTRODUCTION AND IMPORTANCE

Impalement injuries are those injuries that result from the injuring object or weapon being stuck on to the victim's body parts. Such cases occur rarely and when they do they pose a great challenge starting from transportation to anesthesia induction and surgical decision. The extremities are the commonest parts of the body where this occurs. Only a few reports of thoracic impalement injuries have been documented in the literature.

CASE PRESENTATION

Here we present a case of a 25 years old male patient who presented 36 hours after sustaining an impalement injury to his left chest by a metallic spear. He was explored via a left posterolateral thoracotomy incision and the spear was removed under direct vision successfully.

CLINICAL DISCUSSION

Thoracic impalement injuries occur very rarely in the civilian setting. The most important pillar in the management of such injuries is to avoid any manipulation of the impaled object outside of an operation theater where it's done under direct vision in a controlled manner. Post-operative care includes tube thoracostomy, antibiotics and chest physiotherapy and the other components of the enhanced recovery after surgery protocol components.

CONCLUSION

Thoracic impalements are extremely uncommon, as are impalement injuries in general. When they do occur, multidisciplinary teams-primarily the surgeon, anesthesiologists, and emergency physicians. Early cardiothoracic consultation and avoiding manipulation of the impaled object by all means necessary outside of operating room along with the standard advanced trauma life support principles are cornerstones in the management of this patients.

Successful management of a thoracoabdominal impalement injury

A 63-year-old female presented to the hospital with a history of alleged accidental fall onto a rusted iron rod. She was hypotensive but stable. Cooling of the rod while cutting the protruding part was performed as per basic trauma life support (BTLS) access. Following resuscitation, she was re-evaluated clinically and radiologically, and prepared for surgery. The iron rod trajectory was shown on computed tomography (CT) scan to be entering through the left popliteal fossa, then traversing the abdominal cavity with injury to the descending colon and the left dome of the diaphragm. At laparotomy the iron rod was removed under vision. The laceration to the left dome of the diaphragm was repaired. The perforation of the descending colon was identified and repaired. Colostomy was deferred as there was no peritoneal contamination. The penetrating thigh wound was debrided. Her recovery was uneventful. She was discharged on postoperative day 15. She came for follow-up as out-patient after 3 weeks and the thigh wound had healed. Impalement injuries are rare and often severe. Most impalement injuries require a multidisciplinary approach. Adequate early resuscitation, proper evaluation and early surgical management is ideal. Immediate stabilisation of the foreign body from the time of encounter is essential. Removal under anaesthesia is mandatory.

Thoraco-abdominal impalement injury with an iron rod: A case report

INTRODUCTION AND IMPORTANCE

Impalement thoracoabdominal injuries are potentially life-threatening due to the associated bleeding and multiple visceral injuries. They are uncommon and often result in severe surgical complications, requiring prompt treatment and extensive care.

CASE PRESENTATION

We present a 45-year-old male patient who fell from a 4.5-meter-high tree and landed on a Schulman iron rod stick, which pierced the patient's right midaxillary line, exiting from his epigastric region and leading to multiple intraabdominal injuries and right pneumothorax. The patient was resuscitated and immediately shifted to the operating theater. The main operative findings were moderate hemoperitoneum, gastric and jejunum perforations, and liver laceration. A right chest tube was inserted, and injuries were repaired with segmental resection, anastomosis, and colostomy procedure with uneventful post-operative recovery.

CLINICAL DISCUSSION

Providing efficient and prompt care is crucial for patient survival. This includes securing the airways, providing cardiopulmonary resuscitation, and aggressive shock therapy to stabilize the patient's hemodynamic status. The removal of impaled objects is strongly discouraged outside the operation theater.

CONCLUSION

Thoracoabdominal impalement injury is rarely reported in the literature; appropriate resuscitative care, prompt diagnosis, and early surgical intervention may minimize mortality and improve the patient's outcomes.

Wooden foreign body impalement through the right shoulder region – an unusual penetrating injury: A case report

BACKGROUND

Impalement of the body is a rare injury and comes with varied presentation. There is no set classification or defined protocols for managing this injury. This case report aims to create awareness among trauma surgeons about unusual presentation and management of such case.

CASE SUMMARY

A 45-year-old man presented to the emergency department with a sharp penetrating wooden plank at right clavicular region between the neck and shoulder following a road traffic accident. The vehicle had crashed into a roadside wooden hut, thus causing an impalement injury. He was meticulously worked up and taken to emergency theatre. The wooden plank was removed and the wound healed uneventfully. Postoperatively, he had fairly good shoulder function and was able to return back to work successfully.

CONCLUSION

Each impalement injury brings in challenges in management as no two cases are the same. The varied presentation and risks involved should be known to medical professionals handling the emergency. Coordinated multidisciplinary team approach is needed for successful outcome.

Multiple impalement injuries of the torso with two metal bars: A case report

Introduction and importance

Impalement injury is a type of penetrating trauma that is rarely mentioned and studied in the medical literature. Patients who could show up at the emergency room are those who got an isolated stab wound in their extremities. The torso injuries are usually fatal in the scene of the accident. We report two metal bars that impaled in the pelvic, back, abdomen and thorax of the patient who was admitted in OR directly.

Case presentation

A 20 year-old construction worker fell down on two metal bars. At the scene; we cut the metallic bars off the column and then we transported the patient keeping the foreign bodys in situ. Right sided tube thoracostomy was done, and then the patient had an exploratory laparotomy detecting vital organs that had be injured before taking out the 2 bars. The technique steps focused mainly on checking heart, lung, liver, kidney, main vessels and spinal cord; respectively.

Clinical discussion

Third world countries should provide a safety environment for construction workers. Surgeons should be able to make a decision to operate the patient immediately without time wasting by unnecessary investigation. This investigation could be useful later intra-operatively.

Conclusion

The safety of workers should be strongly recommended in non-developed countries and it plays a main role in the rescuing. More case series are needed to share and improve the medical practice in dealing with this rare but fatal situation.

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Multiple impalement injuries are more common and fatal in non-developed countries.

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Intra-operative X-rays is more safety and time saving than the pre-operative one.

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Exploring the whole entire abdomen before trying to pull any metal bar.

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Surgeons detect the priority of which vital organs should be firstly checked and treated.

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Surgeons detect the priority of which bar should be firstly pulled.

Sledge Hammer Impalement: a case report of challenges of managing a patient with a heavy pendant

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This patient suffered an impalement injury by falling on the upright handle of a sledge hammer.

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The hammer head was too heavy for patient transport hence patient was fixed to small sized but heavy hammer head.

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Patient had to be moved simultaneously with the sledge hammer.

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We argue that this meets the definition criteria for transfixion injury.

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We propose that transfixion injury be defined in terms of weight of the impaling object relative to the weight of the patient and ability to mobilize the patient and not necessarily by size of the impaling object.

Introduction

Impalement injuries are well defined. Transfixion injuries involve impalement and are defined in terms of fixation usually to a large object.

Case Report

We report a spectacular case of sledge hammer impalement in the neck where the patient was transfixed, albeit to a small object, requiring movement of the patient and the transfixing object as a single unit.

Discussion

The patient was fixed to the head of the sledge hammer because he was unable to move with the heavy pendant.

Conclusion

We argue that transfixion injuries should be defined in terms of weight of the object in relation to the patient‘s weight and the ability of the patient to move (with) the impaling object.

Thoraco-abdominal impalement injury with two construction ironbars - A rare case report

INTRODUCTION

The work has been reported in line with the SCARE criteria. Thoracoabdominal impalement injuries are uncommon and very few cases have been reported. Impalement injuries result when a rigid object penetrates and remains lodged within the body. It has complex anesthetic and surgical management. We describe the successful surgical and anesthetic management of a major impalement injury of the torso.

CASE REPORT

A 21-year old male construction worker brought to emergency with two iron construction rods impaled in torso due to fall from 2nd floor while working. Both were 1 m long and 12 mm in diameter. One had penetrated from right anterior axillary fold, deep to pectoralis major, exiting from left sternal border. Second entered below the tip of right scapula and exiting from left of xiphoid process. ATLS protocols were followed and patient resuscitated, immediately shifted to operating room, intubated in semi left lateral position. Rod impacted in right pectoral area was superficial with no injury to ribs or pleural space. Other was removed through laparotomy, thoracotomy and Hepatotomy, as it had pierced diaphragm and liver. Post-operative recovery was uneventful.

DISCUSSION

Resuscitation and close monitoring prior to and during surgery are vital with anticipation of major organ and vascular injuries. Hypovolemia should be corrected in the OR. Progressive dyspneacan be the most important symptom in patients with penetrating chest injury.

CONCLUSION

Penetrating abdominothoracic injuries demand immediate life-saving measures, appropriate resuscitative care, urgent shifting of patient to tertiary care center, prompt diagnosis and immediate surgical intervention. Regulation of safety rules at construction site and early intervention in case of accidents can improve the patient outcome and minimize mortality.

Thoraco-abdominal impalement injury with two construction iron bars - A rare case report

INTRODUCTION

The work has been reported in line with the SCARE criteria. Thoracoabdominal impalement injuries are uncommon and very few cases have been reported. Impalement injuries result when a rigid object penetrates and remains lodged within the body. It has complex anesthetic and surgical management. We describe the successful surgical and anesthetic management of a major impalement injury of the torso.

CASE REPORT

A 21-year old male construction worker brought to emergency with two iron construction rods impaled in torso due to fall from 2nd floor while working. Both were 1 m long and 12 mm in diameter. One had penetrated from right anterior axillary fold, deep to pectoralis major, exiting from left sternal border. Second entered below the tip of right scapula and exiting from left of xiphoid process. ATLS protocols were followed and patient resuscitated, immediately shifted to operating room, intubated in semi left lateral position. Rod impacted in right pectoral area was superficial with no injury to ribs or pleural space. Other was removed through laparotomy, thoracotomy and Hepatotomy, as it had pierced diaphragm and liver. Post-operative recovery was uneventful.

DISCUSSION

Resuscitation and close monitoring prior to and during surgery are vital with anticipation of major organ and vascular injuries. Hypovolemia should be corrected in the OR. Progressive dyspnea can be the most important symptom in patients with penetrating chest injury.

CONCLUSION

Penetrating abdomino-thoracic injuries demand immediate life-saving measures, appropriate resuscitative care, urgent shifting of patient to tertiary care center, prompt diagnosis and immediate surgical intervention. Regulation of safety rules at construction site and early intervention in case of accidents can improve the patient outcome and minimize mortality.

Cardiac impalement injury by a steel rebar: A case report

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Cardiac impalement injuries may be fatal.

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We report a patient with cardiac injury due to penetration by a steel rebar.

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The patient also sustained pulmonary injuries.

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The steel rebar was pulled out gradually during cardiopulmonary bypass (CPB).

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CPB is an effective surgical treatment even if there is a risk of bleeding.

Introduction

Penetrating cardiac injury often occurs in South Korea. However, impalement injury of the heart with other organs is rare and fatal. We present a case of cardiac impalement injury by a steel rebar.

Presentation of case

A 38-year-old man was brought to the emergency room with a steel rebar of 45.5 cm in length in situ. Chest tomography revealed that the rebar had entered the thorax to the right diaphragm via the left shoulder while piercing the heart. The patient was immediately taken to the operating room for surgery without removing the bar. We were able to rescue the patient with an emergency operation wherein the bleeding site was treated by pulling the steel rebar out step-by-step while performing cardiopulmonary bypass.

Discussion

Early diagnosis and rapid surgery are important factors for patients with cardiac impalement injury. Haemostasis must be achieved patiently step- by- step without removing the foreign object at once. CPB is an appropriate treatment, even if there is a risk of bleeding.

Conclusion

This case highlights the importance of immediate surgical treatment for the survival of severe thoracic impalemant injury patients.