Triple impalement by fishing spears ('teta'): Surgical decision-making and multisite management in a resource-limited setting - A case report

Penetrating injury is an important reason for hospital admission. In case of multiple penetrating injury early resuscitation, adequate examination and investigation with proper surgical management sequence can significantly reduce the risk of morbidity and mortality. A 34-year-old male from a border area of Sylhet, Bangladesh, presented to the emergency department 6 h after being assaulted with three iron fishing spears ("teta"). The patient had impalement injuries to the left cheek, left lumbar region, and left foot. On admission, he was conscious and hemodynamically stable, though with abdominal distension. Radiological investigations confirmed deep soft tissue and visceral penetration. An emergency laparotomy revealed perforations in the transverse colon and ileum, necessitating segmental repair and jejunostomy due to concerns of delayed presentation, bowel edema, and risk of anastomotic failure in a resource limited setting. All three foreign bodies were successfully removed surgically at Sylhet MAG Osmani Medical College Hospital, Bangladesh. Postoperative recovery was uneventful. This case highlights the importance of multidisciplinary surgical intervention, and resilience in managing complex penetrating injuries in a resource limited setting.