Abraham Zephania Saitabau, Lomnyack Wilson Paulo, Kimario Olivia Michael, Kahinga Aveline Aloyce
Department of Surgery-University of Dodoma, School of Medicine and Dentistry, Dodoma, Tanzania.
Department of Emergency Medicine-Muhimbili National Hospital, Tanzania.
Int J Surg Case Rep. 2021 Nov;88:106484. doi: 10.1016/j.ijscr.2021.106484. Epub 2021 Oct 7.
Jael's syndrome, an intentional injury caused by a knife in the face or skull is a rare encounter in clinical and forensic practice, rarely involving an impacted knife. Clinical and radiographic diagnosis is essential to identify severity of injury and location of the retained knife. To the best of our knowledge, this is the first reported novel case of Jael's syndrome in Tanzania.
We present the case of a 31-year old man admitted at Muhimbili National Hospital following an impacted knife. The stab wound extended to the medial wall of left orbit and ended just before the optic foramen associated with vitreous hemorrhage and the retained knife caused superoposterior displacement of the globe. Multidisciplinary management was instituted including prompt evaluation, imaging and surgical removal of the knife under general anesthesia.
Plain skull X-ray revealed an extensive retained blade and computerized tomography (CT) showed the tip of the blade adjacent to the right styloid process with no neurovascular compromise. Initial concern was the left eye that was reported to be viable by ophthalmologists. Incredibly, the patient had no initial sequelae from such an extensive injury and had unremarkable recovery with no complications apart from the wound to left inferior rectus muscle that was conservatively managed. Simple withdrawal of the retained knife was successful.
Craniofacial retained knives are rare. Thorough prompt initial evaluation and intervention is vital since improper management can be devastating.
耶尔综合征是一种因面部或颅骨被刀故意刺伤导致的损伤，在临床和法医实践中较为罕见，涉及嵌入刀的情况更是少见。临床和影像学诊断对于确定损伤严重程度及留存刀具位置至关重要。据我们所知，这是坦桑尼亚首例报道的耶尔综合征新病例。
我们报告一名31岁男性因刀嵌入后入住穆希姆比利国家医院的病例。刺伤伤口延伸至左眼眶内侧壁，止于视神经孔前方，伴有玻璃体积血，留存的刀具导致眼球向后上方移位。采取了多学科管理措施，包括迅速评估、成像以及在全身麻醉下手术取出刀具。
头颅X线平片显示有大片留存刀片，计算机断层扫描（CT）显示刀片尖端靠近右茎突，无神经血管损伤。最初关注的是眼科医生报告有存活可能的左眼。令人惊讶的是，患者在如此严重的损伤后最初并无后遗症，除了左下直肌伤口采取保守治疗外，恢复情况良好，无并发症。成功简单地取出了留存的刀具。
颅面部留存刀具罕见。进行全面、迅速的初始评估和干预至关重要，因为管理不当可能造成严重后果。
