Traumatic ventricular septal defect following a stab wound to the chest

Self-inflicted Stabbings as Nonfatal Suicide Attempts: A Systematic Review and Case Series

BACKGROUND

Suicide by cutting or piercing is a rare and often nonlethal method. Self-stabbings are a subset of these cases, which can lead to significant injuries. Current literature does not adequately summarize the psychiatric characteristics of this population.

OBJECTIVE

To examine the psychiatric presentations of adults with nonfatal self-inflicted stabbing suicide attempts to better inform the evidence-based care provided by the psychiatric consult service.

METHODS

We searched Embase, Ovid MEDLINE, APA Psych INFO, and CINAHL for studies published within the last 15 years. All full-article case reports, case series, cohort studies, and systematic literature reviews in English were included. Studies not specific to adult (>18 years old) patients with self-inflicted stabbing wounds were excluded. Included studies were separated into 2 groups: case reports and cohort studies. Simple summative statistical analyses were performed. The quality of evidence was assessed using a modified version of the Joanna Briggs Institute Critical Appraisal Tools.

RESULTS

Thirty-four case reports, 3 cohort studies, and zero systematic literature reviews met the inclusion and quality assessment criteria. A total of 184 cases of self-stabbing were identified, 66% of which included male patients. The mean age of cohort patients was 44 years. The mean age of case report patients was 47 years. The most common tool for stabbing was a knife. Common stabbing locations included the neck, chest, and abdomen. Commonly reported psychiatric diagnoses included mood disorders and schizophrenia spectrum disorders. Self-stabbing characteristics important to psychiatry were inconsistently reported across studies.

CONCLUSIONS

This literature review found that self-stabbing appears to be a male-preferred method and may be associated with mood disorders. Inconsistent reporting of relevant psychiatric data such as psychiatric diagnosis, previous psychiatric history, suicidal intent, and intoxication is present in our review and is potentially due to a lack of reports from the psychiatric perspective. This limits our understanding of psychiatric issues in adults who made nonfatal self-inflicted stabbing suicide attempts. A further study into the presentations of this population is needed to better understand this distinct group of patients.

Delayed diagnosis of traumatic ventricular septal perforation in penetrating chest injury: hematoma formation in the ventricular septum in CT suggests perforation

Background

Ventricular septal perforation (VSP) can be caused by a penetrating cardiac injury. Diagnosis of VSP tends to be delayed because a shunt might not be detected by color flow Doppler at an early stage following injury.

Case presentation

A 60‐year‐old man with depression was admitted to the emergency center after a knife injury in the chest. A focused assessment with sonography for trauma revealed cardiac tamponade. Shortly after an open cardiac massage and a pericardiotomy, his spontaneous circulation returned. At a later stage, follow‐up computed tomography, echocardiography, and left ventriculography showed traumatic ventricular septal perforation. Conservative therapy was chosen because the pulmonary blood flow/systemic blood flow ratio was 1.42.

Conclusion

The initial contrast computed tomography shows a septal hematoma. Its presence could be perceived as a perforation site in the interventricular septum.

How to mend a broken heart: a major stab wound of the left ventricle

A 28-year-old male admitted with a stab wound under his left nipple, underwent emergency surgery because of confusion, a decreasing blood pressure and increasing tachycardia. A median sternotomy incision was made and after establishing cardiopulmonary bypass, a 7 cm wound in the left ventricle and a smaller wound in the left atrium were repaired. An injured segment of lung was resected and the left anterior descending and circumflex arteries were grafted after weaning from cardiopulmonary bypass was initially unsuccessful. Although the patient suffered a stroke, probably due to prehospital hypoperfusion, he eventually recovered without major sequelae. In addition to the case report we present a literature review of the last 15 years pertaining the management of penetrating cardiac injury.