Successful management of a thoracoabdominal impalement injury

Abstract

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.