A case report of a polytrauma patient with penetrating iron rods in thorax and head

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.

An unusual foreign body ricocheting into the pericardium after a penetrating thoracic injury: A case report

INTRODUCTION AND IMPORTANCE

Injuries to the thorax are common in trauma patients, among whom cardiac injuries are most lethal, particularly in the setting of penetrating trauma.

CASE PRESENTATION

In this case report, the foreign body was visualized to be lodged in between the left atrium and ventricle. After that, an emergency open heart surgery was performed. Post-intervention, the patient was shifted to the intensive care unit without ionotropic support and with stable haemodynamics.

CLINICAL DISCUSSION

Cardiac foreign bodies are rarely seen because most patients with penetrating cardiac injuries die from hemorrhagic shock or cardiac tamponade.

CONCLUSION

We report a case of a penetrating injury into the thorax with the foreign body being lodged into the pericardium and then managed surgically. The patient was discharged subsequently and followed up after a few days with progressive recovery.

An Unexpected 12.6 Centimeter Nail in the Thorax Damaging Vital Structures: A Case Report “Nailed It”

We report a patient who was referred to the emergency room with pulmonary complaints and where a computed tomography (CT) scan showed an unexpected 12.6 cm nail in the thorax penetrating part of the left pulmonary upper lobe, the left pulmonary artery, the left main bronchus, and the descending aorta, which had been in situ for at least three days. The quickly deteriorating patient had to be transferred to a tertiary academic hospital where the nail was successfully surgically removed. The comprehensive description of this unique case with a discussion of the critical decision moments could render insights into the management of challenging trauma cases.

Impalement injury of the perineum with an iron rod with a minimal injury: A near miss: A case report

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Perineal impalement injuries are often fatal.

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We report a perineal impalement injury by an iron rod piercing the perineum with minimal external and internal injuries.

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Urgent laparotomy to manage all the potential injuries along with effective resuscitation and prehospital care are critical.

Introduction and importance

Penetrating perineal injury in children is uncommon. However, the injury is serious and life-threatening with significant morbidity and mortality.

Case presentation

We report an unusual case of a 13-year-old boy with an accidental perineal impalement injury by an iron rod, which pierced through the perineum and exited through the left loin, however with minimal external and internal injuries.

Clinical discussion

Multiple vital organs in the pelvic space are vulnerable to damage in perineal impalement injury. Vital organ injury, amount of blood loss, and effectiveness of the resuscitation determine the outcome of an impalement injury. Urgent laparotomy forms the cornerstone in management as all the potential injuries can be identified and managed immediately.

Conclusion

Effective resuscitation and accurate assessment of the associated injuries along with proper pre-hospital care with a multidisciplinary approach is crucial for the survival and optimum outcome of the victim.

Major penetrating thoracic trauma - The importance of collaboration between different specialties

Introduction

Penetrating thoracic trauma presents a rare and serious condition with great diversity in impalement mechanisms and following injuries, resulting in a high mortality. This case reports successful management of a severe thoracic trauma and need for collaboration between surgical specialties.

Presentation of case

An 18-year-old, otherwise healthy, Caucasian female had penetration of the chest with a wooden post due to a solo car accident and was admitted to a Level 1 trauma center at a university hospital. Trauma computed tomography scan showed costa fractures and fracture of the left clavicular bone. Damage to the subclavian artery, the brachial plexus and pulmonary artery were suspected. Extracorporeal circulation was on standby at surgery. However, removal of the foreign object did not result in any major bleeding. The patient was discharged from hospital on the 19th day after surgery. Fifteen months after the trauma, surgery was performed to remove the first two costae on the left side, as a disfiguring prominence on the neck was the patients' only complaint.

Discussion

Initial management of the patient should follow ATLS® principles with stabilization of airways, breathing and circulation. Multidisciplinary approach resulted in reconstruction of vessels, debridement and wound closure. The importance of follow-up after trauma and surgery are underlined by the current case, as the patient required additional surgery at follow up.

Conclusion

Multidisciplinary approach to the current penetrating trauma resulted in rapid assessment of injuries and management with excellent outcome.

Conservative management of abdominoperineal impalement trauma - A case report

INTRODUCTION

Adult perineal impalement injuries are uncommon and notorious for their complex injury pattern and risk of massive pelvic bleeding. They present a challenge for the treating physician as there is no consensus about the optimal treatment in the existing literature. In most cases patients need operative intervention.

CASE PRESENTATION

In this article the authors present a case report of a 63-year old man with an impalement injury in the left gluteus, who was managed conservatively.

DISCUSSION

With the recent trends towards conservative management of abdominal penetrating trauma, increased morbidity and costs associated with nontherapeutic laparotomy, conservative management of impalement injuries in hemodynamically stable patients should be considered. Accurate determination of the impaling object trajectory path is vital for the decision and aids to answer two important questions: Did the impaling object enter the peritoneal, retroperitoneal or pelvic cavity? Is there an injury that will require an operation?

CONCLUSION

Abdominoperineal impalement injuries have high mortality, but those patients, who manage to reach hospital alive, can sometimes be manages conservatively, as shown in our case report.

Accidental neck and chest penetration by a metal sliver derived from an axe for wood chopping: a case report

Background

Penetrating neck and chest trauma is a very common entity in emergency medicine that usually requires surgical treatment. Our case report illustrates the case of a 27-year-old Arabian man with hemopneumothorax associated with pneumomediastinum due to an unusual occupational injury.

Case presentation

A metal sliver, coming from an axe using for wood chopping, penetrated the neck of a 27-year-old Arabian man in the left supraclavicular region mimicking a gun bullet; the entrance hole was at the left pleural dome where the sliver had just penetrated the apex of the lung passing through the upper lobe of his left lung creating an exit wound in the dorsal segment of the same lobe arriving in the posterior thoracic wall. Biportal video-assisted thoracic surgery was performed to remove blood clots and the unusual foreign body. 

Conclusion

In the literature, there are several case series about this topic, with some of them reporting unusual foreign bodies that lead to penetrating trauma. However, to the best of our knowledge, no cases like the one we have reported are described in the current literature.

Gluteal, abdominal, and thoracic multiple impalement injuries: A case report on management of a complex polytrauma

RATIONALE

Historically, traumatic injuries include penetrating and blunt lesions. Impalement injury represents one of the rarest and potentially dramatic forms of penetrating trauma. If patient reaches hospital alive and is hemodynamically stable, there is a good chance that patient overcomes the traumatic event. However, non-removal of foreign body represents the cornerstone in initial treatment of this type of patients.

PATIENT CONCERNS

A stable 55-year-old woman was admitted to the Emergency Department after falling out of a tree onto a wooden fence. One fence pole transfixed left gluteus, left abdominal wall, left abdominal cavity, and left thoracic wall by transdiaphragmatic way.

DIAGNOSIS

Due to patient stability, a chest-abdomen CT scan with contrast medium was performed. It showed multiple parietal and visceral traumatic penetrating injuries from a foreign object.

INTERVENTIONS

After primary and secondary advanced trauma life support (ATLS) assessment, patient underwent successful surgery.

OUTCOMES

Patient was discharged on 9th postoperative day in good general clinical condition.

LESSONS

Impalement injury represents a rare and potentially lethal traumatic event. Unstable patients rarely reach Emergency Department alive. On the contrary, stable patients have a good chance of successful treatment, if they are quickly taken to tertiary Trauma Center. In this case, chest X-ray and Focused Assessment with Sonography for Trauma (FAST) represent useful diagnosing investigations, although CT scan remains gold standard. Conservative treatment is not possible, while thoracoscopy/laparoscopy/laparotomy is/are mandatory.