Djelti Abdellatif, Jneid Hamida
Department of Orthopaedics and Traumatology, C.H.U. Lamine Debaghine, Bab El Oued, Algiers, Algeria.
Department of General Surgery, C.H.U. Lamine Debaghine, Bab El Oued, Algiers, Algeria.
Int J Surg Case Rep. 2020;68:270-272. doi: 10.1016/j.ijscr.2020.02.064. Epub 2020 Mar 7.
Abdominal impalement by spear is fortunately exceptional. In the literature, only twenty cases have been so far reported. In most cases, transfixing wounds result in serious visceral and/or vascular lesions with a high risk of mortality. Those cases need careful planning and a preoperative order to properly control the spring harpoon during extraction. The extraction of the spear is a delicate process requiring a thorough study of each case to avoid further damage to the patient. This case is written following the SCARE scale for case report writing.
We report the case of a 39-year patient, admitted to the hospital only after 13 h after the accident. No visceral or vascular lesion was observed, except minimal liver damage to the 3rd liver segment. The liver was almost spared in only the third segment was lightly touched and regarding the vascular and visceral apparatus, no serious lesions were highlighted.
The marking problem we encountered with this patient was that the harpoon ended by a mobile spring beard, which led to a profound lesion and also, to a certain difficulty to get access to it. Also, because of the aorta wound, the surgical approach was chosen, allowing a good exposure of the object.
When it comes to abdominal impalement, following the rules of transporting and mobilizing the patient, using the infectious risk prevention and knowing the importance of the initial assessment of damage aided by radiology, can allow better management of the situation.
长矛刺入腹部的情况所幸较为罕见。在文献中,迄今为止仅报道过20例。在大多数情况下,贯通伤会导致严重的内脏和/或血管损伤,死亡率很高。这些病例需要精心规划并制定术前医嘱,以便在拔出过程中妥善控制弹簧鱼叉。拔出长矛是一个精细的过程,需要对每个病例进行全面研究,以避免对患者造成进一步伤害。本病例报告遵循SCARE病例报告撰写规范。
我们报告一例39岁患者的病例,该患者在事故发生13小时后才入院。除第三肝段有轻微肝损伤外,未观察到内脏或血管损伤。肝脏几乎未受影响,仅第三段略有损伤,且就血管和内脏器官而言,未发现严重损伤。
我们在该患者身上遇到的标记问题是,鱼叉末端有一个可移动的弹簧倒刺,这导致了严重的损伤,也给取出鱼叉带来了一定困难。此外,由于主动脉受伤,选择了手术入路,以便能很好地暴露异物。
对于腹部刺伤,遵循患者转运和移动的规则,采取感染风险预防措施,并了解借助放射学进行初始损伤评估的重要性,能够更好地应对这种情况。