Successful management of left-sided thoracic impalement in a resource-limited setting: A case report

Abstract

Introduction: Thoracic impalement injuries are rare and life-threatening. Managing them in resource-limited settings poses significant challenges.

Case presentation: A 63-year-old male fell 3 m from a tree, sustaining a left-sided chest impalement at the 7th intercostal space along the mid-axillary line. On arrival, his vitals were BP 100/70 mmHg, pulse 104 bpm, RR 32/min, and SpO₂ 78 % (improving to 90 % with oxygen). Examination revealed absent air entry on the left, a sucking chest wound, and an impaled wooden fragment. Initial management included resuscitation, antibiotics, and tetanus prophylaxis. A left anterolateral thoracotomy revealed 7th and 8th rib fractures, lung damage, and an embedded wooden object, which was removed with wedge resection and chest tube placement. The patient had an uneventful recovery and was discharged in stable condition.

Discussion: Thoracic impalement injuries pose significant challenges due to the risk of severe hemorrhage, infection, and organ damage. Left-sided injuries are particularly critical due to proximity to the heart and great vessels. Avoiding premature removal of the foreign object, prioritizing hemodynamic stabilization, and expediting surgical intervention are key principles in management.

Conclusion: Timely intervention, controlled foreign body removal, and adherence to trauma protocols are essential for successful management of thoracic impalement injuries, even in resource-limited settings.

Keywords: Case report; Foreign body removal; Penetrating chest trauma; Resource-limited setting; Thoracic impalement.

Fig. 1

Preoperative image of the impaled wooden object.

Fig. 2

Intraoperative image showing left lung parenchymal injury.

Fig. 3

Postoperative chest X-ray on day 2 showing lung expansion.