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. 2019:61:123-126.
doi: 10.1016/j.ijscr.2019.07.043. Epub 2019 Jul 23.

Management of chest impalement injury

Carlo Bergaminelli  1 , Rosario Salvi  1 , Dario Maria Mattiacci  2 , Giovanni Messina  3 , Marcellino Cicalese  1 , Carlo Curcio  1 , Salvatore Buono  3 , Antonio Corcione  3 , Marco Rispoli  3
Affiliations

Management of chest impalement injury

Carlo Bergaminelli et al. Int J Surg Case Rep. 2019.

Abstract

Presentation of case: We will describe the case of a man who impaled himself on a greenhouse pole by falling off a ladder.

Discussion: The belated radiological exclusion of any spine and neck lesions forced the surgeons to operate with the patient supine and on a spine board, which prevented them from performing the classic thoracotomy and reaching the entry hole in the right scapula area.

Conclusion: A double thoracotomy and the expedient of a haemostatic plug, positioned simultaneously with the extraction of the pole, allowed to control bleeding with absolute safety margins.

Keywords: Bleeding; Chest wall; Penetrating; Thoracic surgery; Trauma.

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Conflict of interest statement

Authors have no conflict of interest.

Figures

Fig. 1
Fig. 1
Patient impaled himself on a pole of a greenhouse. The pole had entered the right side of the back to exit the sternum. (1A) Entrance hole, (1B) exit hole.
Fig. 2
Fig. 2
Chest CT scan: Tubuliform foreign body in the right lateral thoracic wall. Conspicuous apical-parietal-basal hemothorax with concomitant atelectasis. Front-basal right pneumothorax and decomposed fractal of the middle arch of the 3rd and 4th ribs.
Fig. 3
Fig. 3
(3A) The thoracic drainage tube was passed through the hole of the pole to the outside of the operating field. (3B) A sterile gauze was fixed to the thoracic drainage. (3C) The removal of the foreign body started from the exit hole, pulling together the pole and the thoracic drainage inside of it. (3D) In this way the gauze at the end acted as haemostatic plug for the tissue injured by the pole penetration, exploiting its immediate mechanical haemostatic action.
See this image and copyright information in PMC

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