Thoraco-abdominal impalement injury with two construction iron bars - A rare case report

The work has been reported in line with the SCARE criteria. Thoracoabdominal impalement injuries are uncommon and very few cases have been reported. Impalement injuries result when a rigid object penetrates and remains lodged within the body. It has complex anesthetic and surgical management. We describe the successful surgical and anesthetic management of a major impalement injury of the torso.

A 21-year old male construction worker brought to emergency with two iron construction rods impaled in torso due to fall from 2nd floor while working. Both were 1 m long and 12 mm in diameter. One had penetrated from right anterior axillary fold, deep to pectoralis major, exiting from left sternal border. Second entered below the tip of right scapula and exiting from left of xiphoid process. ATLS protocols were followed and patient resuscitated, immediately shifted to operating room, intubated in semi left lateral position. Rod impacted in right pectoral area was superficial with no injury to ribs or pleural space. Other was removed through laparotomy, thoracotomy and Hepatotomy, as it had pierced diaphragm and liver. Post-operative recovery was uneventful.

Resuscitation and close monitoring prior to and during surgery are vital with anticipation of major organ and vascular injuries. Hypovolemia should be corrected in the OR. Progressive dyspnea can be the most important symptom in patients with penetrating chest injury.

Penetrating abdomino-thoracic injuries demand immediate life-saving measures, appropriate resuscitative care, urgent shifting of patient to tertiary care center, prompt diagnosis and immediate surgical intervention. Regulation of safety rules at construction site and early intervention in case of accidents can improve the patient outcome and minimize mortality.