Transdiaphragmatic wooden impalement with multi-organ injury: a case report

A 29-year-old male sustained a penetrating abdominothoracic injury after falling onto a sharpened wooden branch. The object entered through the right hemiscrotum, traversed the abdomen, and extended through the diaphragm into the left pleural space. On admission, he had hemorrhagic shock, hypoxemia, tachypnea, and hypotension. Computed tomography showed hemoperitoneum, bowel and mesenteric injuries, diaphragmatic rupture, left hemopneumothorax, pulmonary contusion, subcutaneous emphysema, and rib fractures. Emergency laparotomy and thoracoscopy included small bowel resections with anastomoses, mesenteric repair, diaphragmatic closure, lung repair, and intercostal artery ligation. About 1 l of blood was evacuated and wooden fragments removed. Postoperatively, fever and leukocytosis required repeat thoracoscopy with decortication and drainage. The patient had paranoid schizophrenia, contributing to injury and requiring psychiatric care. Medication stabilized mental state, enabling orientation and consent. This case highlights complexity, need for multidisciplinary care, and challenges of psychiatric comorbidity. Close monitoring and coordinated follow-up ensured recovery without major complications.