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Major mediastinal injury from crossbow bolt
S A Endara1, A A Xabregas, C S Butler
1Department of Cardiothoracic Surgery, Townsville General Hospital, Queensland, Australia. santiago_endara@health.qld.gov.au
Insights
A young male survived a severe self-inflicted crossbow injury to the chest, involving the heart and major vessels. Successful treatment required cardiopulmonary bypass and hypothermia, highlighting advanced trauma care capabilities.
Area of Science:
- Cardiovascular Surgery
- Thoracic Trauma Management
- Emergency Medicine
Background:
- Penetrating chest trauma presents significant challenges in emergency care.
- Mediastinal injuries, especially those involving great vessels, have high mortality rates.
- Prompt and effective surgical intervention is critical for survival.
Observation:
- A 26-year-old male presented with a self-inflicted mediastinal injury from a crossbow bolt.
- The injury traversed the sternum, right lung, pericardium, ascending aorta, right pulmonary artery, esophagus, and azygos vein.
- This case represents a rare and complex penetrating thoracic trauma scenario.
Findings:
- The patient underwent successful surgical repair utilizing cardiopulmonary bypass and hypothermia.
- Surgical exposure involved a combined sternotomy and right thoracotomy approach.
- The patient survived this life-threatening injury with timely and aggressive management.
Implications:
- This case underscores the importance of advanced life support and surgical expertise in managing severe penetrating mediastinal trauma.
- It demonstrates the feasibility of utilizing cardiopulmonary bypass and hypothermia in complex vascular and airway reconstructions.
- Successful outcomes in such critical injuries depend on rapid diagnosis, multidisciplinary collaboration, and specialized surgical techniques.
Abstract:
We treated a 26-year-old male who sustained a self-inflicted injury to the mediastinum with a crossbow bolt. Injuries involved penetration of the sternum 1 cm below the sternomanubrial joint, right lung, pericardium, ascending aorta, right pulmonary artery, esophagus, and azygos vein. He was treated successfully with cardiopulmonary bypass and hypothermia. Exposure was achieved with a combination of a sternotomy and right thoracotomy.