Survival against anatomical odds: Management of a 143-cm transdiaphragmatic, transspinal rod impalement-A case report

Impalement injuries are rare but often fatal injuries due to their complex nature involving multiple organ systems and the risk of massive hemorrhage. Patient outcome depends upon early resuscitation, the location, extent of organ involvement and post-operative care.

We report a case of a 55-year-old man who fell onto an exposed rod from approximately 10 ft in height. On presentation to the Emergency Department in an ambulance, he was hemodynamically stable. He had absent sensory and motor functions below the T7-T8 levels of the trunk. Multiplanar CT showed rod impalement traversing the abdomen, thorax, and vertebral canal causing spinal cord transection, but without visceral/vascular injuries. He was taken to the operating theater, and laparotomy was performed, and the rod was extracted under direct vision. Post-operatively, he was managed with broad-spectrum antibiotics and supportive measures. He was discharged on the 8th post-operative day in stable condition.

Patients with thoracoabdominal impalement should be managed in accordance with Advanced Trauma Life Support (ATLS) principles. Computed Tomography (CT) scan is the diagnostic modality of choice. Early hemodynamic stabilization followed by definitive removal in the operating room under direct vision is recommended. Meticulous postoperative care is crucial for optimal recovery.

This report aims to emphasize that not all extensive impalement injuries lead to fatal outcomes. Prognosis depends on the mechanism of injury, resuscitation, management approach, and post-operative care.