Gluteal, abdominal, and thoracic multiple impalement injuries: A case report on management of a complex polytrauma

Perineal impalement extending through multiple cavities by iron rod following fall from elevated plane: Case report

INTRODUCTION

Perineal impalements, although rare, exhibit high morbidity and mortality, associated with penetrating traumas by long objects, often resulting from falls or assaults. The risk of pelvic bleeding and the need for immediate intervention to preserve vital organs are characteristics of these injuries, whose severity demands a multidisciplinary approach.

CASE DESCRIPTION

A 57-year-old male patient, a victim of a 5-meter fall, suffered an extensive perineal impalement. With stable vital signs, he underwent the ATLS protocol, followed by whole-body computed tomography (WBCT), revealing a metallic object traversing the perineum, abdomen, and thorax. The surgery involved laparotomy, sternotomy, and removal of the object under direct visualization, with repair of prostatic, vesical, hepatic, and diaphragmatic injuries. The postoperative period included transfusions and urological follow-up.

DISCUSSION

Perineal impalements require immediate attention, and their approach is influenced by clinical factors and the extent of the object. The importance of preoperative evaluation with tomography, removal of the object under direct visualization, and comprehensive surgical management is highlighted. The decision for conservative treatment is reserved for less severe cases. This work has been reported in line with the SCARE criteria.

CONCLUSION

Perineal impalements demand a rapid and integrated approach to optimize survival. Object removal, often performed by exploratory laparotomy, stands out as an essential procedure. Multidisciplinary expertise is crucial for the effective management of these complex injuries.

METHODS

This work has been reported in line with the SCARE criteria.

Thoraco-abdominal impalement injury with an iron rod: A case report

INTRODUCTION AND IMPORTANCE

Impalement thoracoabdominal injuries are potentially life-threatening due to the associated bleeding and multiple visceral injuries. They are uncommon and often result in severe surgical complications, requiring prompt treatment and extensive care.

CASE PRESENTATION

We present a 45-year-old male patient who fell from a 4.5-meter-high tree and landed on a Schulman iron rod stick, which pierced the patient's right midaxillary line, exiting from his epigastric region and leading to multiple intraabdominal injuries and right pneumothorax. The patient was resuscitated and immediately shifted to the operating theater. The main operative findings were moderate hemoperitoneum, gastric and jejunum perforations, and liver laceration. A right chest tube was inserted, and injuries were repaired with segmental resection, anastomosis, and colostomy procedure with uneventful post-operative recovery.

CLINICAL DISCUSSION

Providing efficient and prompt care is crucial for patient survival. This includes securing the airways, providing cardiopulmonary resuscitation, and aggressive shock therapy to stabilize the patient's hemodynamic status. The removal of impaled objects is strongly discouraged outside the operation theater.

CONCLUSION

Thoracoabdominal impalement injury is rarely reported in the literature; appropriate resuscitative care, prompt diagnosis, and early surgical intervention may minimize mortality and improve the patient's outcomes.

Rare penetrating abdominal injury caused by falling from height: Miraculously good prognosis

Fall from height causing penetrating abdominal visceral injuries is rare condition leading to abdominal multiorgan damage. It carries high mortality. A case of construction site worker sustaining penetrating visceral injuries by falling from height leading to impalement of steal bar from anus presented to our hospital and managed by timely evacuation from site of accident to hospital, resuscitations, radiological investigations and multi-Disciplinary team management lead to successful outcome. Our protocol for such cases will be discussed with references.

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.