Penetrating pencil injury: an unusual case of child abuse

Proximal migration of retained pencil lead along a flexor tendon in the hand: A case report

RATIONALE

The hand is the most common site for foreign body injuries. Pencil lead penetration mainly occurs in school-age children.We report a case of proximal migration of a retained pencil lead in the hand, emphasizing the importance of adequate imaging and prompt removal of the foreign body.

PATIENT CONCERNS

We report the case of an 8-year-old boy who visited our outpatient clinic for a retained foreign body in the right palm. Removal was planned under general anesthesia. Black staining from the pencil lead was observed around the tendon sheath in the operative field, but the foreign body itself was not apparent.

DIAGNOSIS

Intraoperative radiography located the foreign body at the wrist, 5 cm away from the original site. Proximal migration of the retained foreign body was suspected.

INTERVENTION

Incision was extended toward the wrist and the foreign body was discovered in the flexor sheath at the wrist.

CONCLUSION

Foreign bodies may migrate to adjacent tissues, but rarely wander far. Computed tomography is the most useful tool in diagnosing a pencil lead foreign body.

LESSONS

Adequate imaging and prompt removal of the foreign body is important. When a retained foreign body is removed after a delay, the physician must always consider the possibility of foreign body migration.

Assaults with a sharp object in small children: a 16-year review

Injuries as a result of assaults with sharp object in small children are rare and data on them are scarce. The Red Cross War Memorial Children's Hospital is presently the only Children's Hospital in South Africa with a dedicated Level 1 trauma unit for children under the age of 13 years, and we have an annual trauma load of over 10,000 patients. A retrospective review was performed using the Data Base of the Child Accident Prevention Foundation of Southern Africa at the Red Cross War Memorial Children's Hospital in Cape Town. All children who were coded as an 'assault with sharp object' were included in this study. Five-hundred-and-fifty-one (551) patients were retrospectively reviewed, of which 373 (68%) were boys and 177 (32%) girls. The mean age of the children was 7 years. The majority of children (51%) sustained injuries at the head or neck region, 26% sustained an injury at the trunk and 26% at the extremities. The majority of children sustained minor injuries (62%), thirty-three (33%) moderate and 5% severe injuries. Three children died. The most commonly recorded object used in the assault was glass or (broken) bottles (33%) and knives (18%). Other objects recorded included sticks, stones, pens, pencils, scissors, machetes and nails. The majority of perpetrators were known to the child. Assaults with a sharp object in small children are relatively rare and represent only 0.328% of all paediatric trauma patients. Although rare, these injuries carry a significant morbidity and even mortality. The majority of injuries occurred at home. Prevention programmes, specifically targeting the caretakers, should be implemented to prevent these tragic injuries.