Penetrating injury of pelvis, abdomen and thorax in a child with a trident (trishula)

Abstract

Penetrating abdominal injuries are uncommon in the pediatric age group and are associated with a high mortality. A seven year old girl suffered penetrating injury to perineum when she fell onto the trident (trishula - traditional three pronged spear) implanted alongside Lord Shiva's idol. The rod caused perforations of the transverse mesocolon, ileum at 3 places, right lobe of liver, diaphragm, parietal pleura, and exited from 7th intercostal space. Surgical repair of each damaged site was undertaken. Despite delayed presentation, the child survived following surgery.

Keywords: Child; Injury; Trident; Trishula; Thoraco-abdomino-pelvic impalement.

Figure 1: Pre-operative picture of the patient. Inset pictures show the trishula, body radiograph, and the entry and exit wounds.

Figure 2: (A) The trishula is seen perforating the right lobe of the liver, (B) The small bowel perforated at three different places, (C) Perforated transverse mesocolon, (D) Entry wound, (E) Exit wound located at the right 7th intercostal space.