Successful Management of Penetrating Right Ventricular Stab Injury with Cardiac Tamponade in a Resource-Limited...

Penetrating cardiac injury with tamponade is a rare but highly lethal form of trauma, and outcomes in low-resource settings are constrained by delays in diagnosis, limited imaging, and lack of cardiopulmonary bypass.

A 15-year-old boy presented 3 hours after a single stab wound to the left anterior chest with hypotension, tachycardia, pallor, and muffled heart sounds. Bedside chest radiography showed an enlarged cardiac silhouette, and extended focused assessment with sonography for trauma demonstrated a large hemopericardium with echogenic clot and tamponade physiology, without significant pleural or intra-abdominal fluid collections. Given ongoing hemodynamic instability and evidence of clotted hemopericardium, the team proceeded directly to emergency median sternotomy rather than temporizing pericardiocentesis. Pericardiotomy released a large volume of blood and organized clot, revealing a 1-cm laceration on the anterior surface of the right ventricle near the left anterior descending coronary artery. The defect was repaired on the beating heart using an autologous pericardial patch with pledgeted polypropylene sutures, without cardiopulmonary bypass. The postoperative course was uneventful, and the patient was discharged on postoperative day 7. At 1-month follow-up he remained asymptomatic, with a normal cardiac silhouette and no evidence of recurrent pericardial effusion on chest radiography.

This case illustrates that, even in a resource-limited Somali tertiary hospital without cardiopulmonary bypass, rapid ultrasound-guided recognition of tamponade, avoidance of diagnostic delays, and prompt beating-heart repair can achieve favorable short-term outcomes after penetrating right ventricular stab injury with cardiac tamponade.