A chair leg as the rare cause of a transabdominal impalement with duodenal and pancreatic involvement

Transabdominal impalement injury by an iron pipe - A case report

Impalement injuries are rare and complex problems, often involving multiple organ injuries. An 18-year-old male was admitted to our emergency department after a car accident. Positioned in the right-side recumbent position, he had a 4.5 cm diameter pipe penetrating from his left abdomen to his back. Given the pipe's length exceeding the CT gantry's capacity, further imaging tests were not feasible. Consequently, the patient proceeded directly to the operating room without preoperative imaging. Before laparotomy, a left thoracotomy was conducted for aortic cross-clamping, anticipating uncontrollable bleeding during pipe removal. The subsequent laparotomy, with the patient in the right-side recumbent position, revealed the pipe impaling through the mesentery of the descending colon without evident major vessel injury. The pipe was cautiously extracted. The patient was subsequently discharged on day 26. The absence of imaging feasibility emphasized that current hemodynamic stability does not rule out the potential for significant vessel injury. Therefore, the sequential approach of left thoracotomy for aortic cross-clamping followed by laparotomy emerges as a potentially beneficial strategy in cases of transabdominal impalement. The impalement injury requires our preparedness and flexibility, which should be tailored to the individual case.

Multiple impalement injuries of the torso with two metal bars: A case report

Introduction and importance

Impalement injury is a type of penetrating trauma that is rarely mentioned and studied in the medical literature. Patients who could show up at the emergency room are those who got an isolated stab wound in their extremities. The torso injuries are usually fatal in the scene of the accident. We report two metal bars that impaled in the pelvic, back, abdomen and thorax of the patient who was admitted in OR directly.

Case presentation

A 20 year-old construction worker fell down on two metal bars. At the scene; we cut the metallic bars off the column and then we transported the patient keeping the foreign bodys in situ. Right sided tube thoracostomy was done, and then the patient had an exploratory laparotomy detecting vital organs that had be injured before taking out the 2 bars. The technique steps focused mainly on checking heart, lung, liver, kidney, main vessels and spinal cord; respectively.

Clinical discussion

Third world countries should provide a safety environment for construction workers. Surgeons should be able to make a decision to operate the patient immediately without time wasting by unnecessary investigation. This investigation could be useful later intra-operatively.

Conclusion

The safety of workers should be strongly recommended in non-developed countries and it plays a main role in the rescuing. More case series are needed to share and improve the medical practice in dealing with this rare but fatal situation.

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Multiple impalement injuries are more common and fatal in non-developed countries.

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Intra-operative X-rays is more safety and time saving than the pre-operative one.

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Exploring the whole entire abdomen before trying to pull any metal bar.

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Surgeons detect the priority of which vital organs should be firstly checked and treated.

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Surgeons detect the priority of which bar should be firstly pulled.

An Unusual Case of Homicide by Impalement With a Battering Ram

Impalement injuries occur when a large foreign body traverses or penetrates a body cavity or extremity. Nowadays, impalement injuries are uncommon and are usually a consequence of a fall onto a blunt object or a road accident. The authors report a case of a woman found dead in her apartment, seemingly killed by a firearm injury to the abdomen. However, after the autopsy was carried out, it became clear that the injuries had the features of an impalement. After the inquiry, the murder weapon was identified as a battering ram, used by the robbers to break into the house of the woman. This is the first case ever described in literature where a battering ram has been used to impale someone. This case emphasizes the importance of an accurate description of injuries, also with photographs, in order to achieve effective recognition of the wound patterns as they may correspond to specific and unusual weapons.

A forensic evaluation of impalement injuries

Impalement injuries transfix a victim in an inescapable or helpless position. A study was undertaken at Forensic Science SA from 2002 to 2016 of all impalement deaths. There were six vehicle accidents (M:F=5:1; age 14-67 years, average age 38.5 years) involving impalements with a tree branch ( n=2; groin and chest), a metal pipe ( n=2; leg and head), a metal bridge railing (groin) and a metal fence post (chest). Two cases (both males, aged 47 and 18 years) had slipped on fences/gates, with impalements of the ankle and groin. A case of suicide (male, aged 80 years) was impaled through the head on a bolt fixed to the floor. A homicide case (male, aged 27 years) involved impalement through the chest by a spear from a spear gun. In certain cases (e.g. with anogenital injuries), differentiating accidental from inflicted impalement injuries may be difficult. In equivocal cases, adequate scene evaluations with photographic documentation are required prior to autopsy, ideally with the object available for examination.

A rare case of a transabdominal impalement after a fall from a ladder

INTRODUCTION

Impalement injuries are caused by objects that penetrate and remain inside the human body. They are rare and often lead to complex surgical problems, demanding immediate measures and intensive care.

PRESENTATION OF CASE

We report a case of a 39 year old male who presented in our emergency department with a history of fall from a 3m high ladder, landing on a wooden stick that penetrated the patient from his left lumbar region, leading to a trans-abdominal impalement injury.

DISCUSSION

Nowadays impalement injuries although rare, demonstrate a challenging presentation for emergency providers. Their complexity often raises concerns about the proper surgical approach and postoperative management. In many cases, they may cause severe morbidity or even be lethal.

CONCLUSION

The article describes a case of a transabdominal impalement injury and pinpoints the strategies followed regarding the prehospital care, as well as the intra- and postoperative management.

Transabdominal impalement: absence of visceral or vascular injury a rare possibility

BACKGROUND

Abdominal impalement injuries are usually associated with visceral and vascular injury, causing significant morbidity and mortality. The management of these injuries poses specific challenges in prehospital care, transport, and management strategies.

OBJECTIVE

We report a case of transabdominal impalement with no injury to intra-abdominal visceral or vascular structures, demonstrating a chance occurrence. The literature regarding abdominal impalement injury is reviewed and the management of these injuries is discussed.

CASE REPORT

A 35-year-old man with a transabdominal impalement injury after an accidental fall from a tree on to a wooden fence was brought to the Accident and Emergency Department. The wooden fence piece was impaled and in situ. Laparotomy revealed no intra-abdominal visceral or vascular injury.

CONCLUSION

Transabdominal impalement injuries pose peculiar challenges in prehospital care, transport to hospital, and management. Operative intervention is required in all cases for a conclusive and safe management, as the possibility of escaping intra-abdominal injury is very rare.

Cervical Impalement Injury

Impacted injuries of the head and neck are uncommon. Associated injuries can be present and can be a serious problem. We present an unusual clinical case and discuss the management of this complex injury. Head and neck injuries deserve special attention because of their enormous functional and esthetic significance. Contusion, abrasion, retained foreign bodies, laceration, and avulsion are some of the most frequent injuries. Impalement injuries are not so common. These lesions combine aspects of blunt and penetrating trauma and usually result from penetration by a large, rigid, blunt-tipped object that traverses a certain body area in a through-and-through fashion and often remains in situ at the time of presentation. There have been many case reports describing these injuries in the trunk and extremities; however, cases of head and neck impalement are still lacking in number. A case of an unusual cervical impalement is presented, together with a discussion of the management of this complex injury.