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

Abstract:

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.

journal_name

Medicine (Baltimore)

journal_title

Medicine

authors

Ugoletti L,Zizzo M,Castro Ruiz C,Pavesi E,Biolchini F,Annessi V

doi

10.1097/MD.0000000000015824

subject

Has Abstract

pub_date

2019-05-01 00:00:00

pages

e15824

issue

22

eissn

0025-7974

issn

1536-5964

pii

00005792-201905310-00050

journal_volume

98

pub_type

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