High-Velocity Penetrating Pelvic Injury With Iron Rod: A Case Report and Literature Review

Penetrating pelvic impalement injuries caused by foreign objects are uncommon and potentially life-threatening due to the risk of severe hemorrhage and multi-organ involvement. We report the case of a 16-year-old female who sustained a penetrating injury when an iron rod/metal rod (handle-like structure) pierced her right gluteal region following a high-velocity road traffic collision. Initial assessment revealed a protruding metal object without active bleeding, and the patient was hemodynamically stable. Preoperative imaging demonstrated the trajectory of the foreign body through the gluteal musculature, penetrating the right iliac blade without involvement of the sacroiliac joint or acetabulum. A multidisciplinary surgical team performed a controlled exploratory laparotomy and removal of the object through a modified iliofemoral approach, with careful debridement and copious irrigation. No major neurovascular or visceral injuries were identified. The postoperative course was uneventful, and the patient was discharged on day 21 with no functional deficits. This case highlights the importance of rapid assessment, meticulous pre-hospital handling, and avoidance of premature removal of impaled objects, which may maintain tamponade and prevent catastrophic bleeding. Definitive extraction should always occur under direct vision in a controlled operative environment. The successful outcome in this case is attributable to early resuscitation, detailed radiological evaluation, strategic surgical planning, and coordinated multidisciplinary involvement. Reporting such rare injuries contributes to improved awareness, clinical decision-making, and evolving management strategies. Early recognition and timely, organized intervention remain crucial to reducing morbidity and mortality in penetrating pelvic trauma.