Open penetrating external laryngotracheal injury and abdominal trauma by suicide attempt successfully treated with immediate intervention: A case report

Abstract

An open penetrating external laryngotracheal injury (PE-LTI) is a rare life-threatening injury requiring immediate intervention. Penetrating injuries may cause tissue loss, which makes wound closure difficult sometimes. Here, we report the case of an open PE-LTI and abdominal trauma by suicide attempt. A 38-year-old Asian man with depression was found in his home after having cut his own neck and abdomen. He was transported to a regional trauma center and immediately intubated. On arrival, his blood pressure was 120/90 mmHg and heart rate was 120 beats/min. Physical examination revealed three cuts each on the neck and abdomen and no dysphonia. The patient's condition was diagnosed as an open PE-LTI, classified as group 5 on the Schaefer classification system and zone II on the Roon and Christensen classification system. He was also evaluated for possible mesenteric injury. We performed an emergency primary laryngotracheal repair and exploratory laparotomy. There was no obvious blood vessel injury, but soft and cartilage tissues were crushed and disconnected completely. On day 8, he underwent wound closure and tracheostomy on the caudal side of the wound. He was successfully weaned from mechanical ventilation on day 9, transferred to the general ward on day 13, decannulated on day 63, and discharged from the hospital thereafter for subacute care. In this case of severe neck injury with complete laryngotracheal separation, tissue losses were relatively minimal. Wound closure presumably occurred early in the absence of blood vessel injury.

Keywords: Complete laryngotracheal separation; Early wound closure; Penetrating external laryngotracheal injury; Suicide.

Fig. 1

(A) Two cuts on the patient's abdomen (transverse wounds measuring 3 cm and 2 cm, respectively). (B) 2-dimensional axial CT showing increased CT value indicative of panniculitis and deep lacerations reaching the peritoneum. (C) Three cuts on the neck (transverse wound measuring 4 cm, superior to the thyroid cartilage; 2 cm, inferior to the thyroid cartilage; and 2 cm, superior to the left sternoclavicular joint). (D) 2-dimensional sagittal CT showing significant subcutaneous emphysema at the level of hyoid bone.

Fig. 2