Melkamu Halid, Bekele Sisay, Hailemariam Berhanu, Yerdaw Wubete, Shiferaw Enku, Shiferaw Yishak
Department of Surgery, St. Paul's Hospital Millennium Medical College, Swazilland street, PO box 1247, Addis Ababa, Ethiopia.
Department of Surgery, St. Paul's Hospital Millennium Medical College, Swazilland street, PO box 1247, Addis Ababa, Ethiopia.
Int J Surg Case Rep. 2023 Dec;113:109074. doi: 10.1016/j.ijscr.2023.109074. Epub 2023 Nov 18.
Impalement injuries are those injuries that result from the injuring object or weapon being stuck on to the victim's body parts. Such cases occur rarely and when they do they pose a great challenge starting from transportation to anesthesia induction and surgical decision. The extremities are the commonest parts of the body where this occurs. Only a few reports of thoracic impalement injuries have been documented in the literature.
Here we present a case of a 25 years old male patient who presented 36 hours after sustaining an impalement injury to his left chest by a metallic spear. He was explored via a left posterolateral thoracotomy incision and the spear was removed under direct vision successfully.
Thoracic impalement injuries occur very rarely in the civilian setting. The most important pillar in the management of such injuries is to avoid any manipulation of the impaled object outside of an operation theater where it's done under direct vision in a controlled manner. Post-operative care includes tube thoracostomy, antibiotics and chest physiotherapy and the other components of the enhanced recovery after surgery protocol components.
Thoracic impalements are extremely uncommon, as are impalement injuries in general. When they do occur, multidisciplinary teams-primarily the surgeon, anesthesiologists, and emergency physicians. Early cardiothoracic consultation and avoiding manipulation of the impaled object by all means necessary outside of operating room along with the standard advanced trauma life support principles are cornerstones in the management of this patients.
穿刺伤是指致伤物体或武器刺入受害者身体部位所造成的损伤。此类病例很少发生，一旦发生，从转运到麻醉诱导及手术决策都会带来巨大挑战。四肢是身体最常发生此类损伤的部位。文献中仅有少数关于胸部穿刺伤的报道。
在此，我们呈现一例25岁男性患者，他在被金属长矛刺入左胸36小时后前来就诊。通过左后外侧开胸切口进行探查，在直视下成功取出长矛。
胸部穿刺伤在平民环境中极为罕见。处理此类损伤最重要的原则是避免在手术室以外对刺入物体进行任何操作，应在手术室中以可控方式在直视下进行操作。术后护理包括胸腔闭式引流、使用抗生素及胸部物理治疗，以及术后加速康复方案的其他组成部分。
胸部穿刺伤极为罕见，一般的穿刺伤亦是如此。当此类损伤发生时，多学科团队——主要是外科医生、麻醉医生和急诊医生。早期心胸外科会诊并在手术室以外尽可能避免对刺入物体进行操作，同时遵循标准的高级创伤生命支持原则，是此类患者治疗的基石。
