Case report: Thoracoabdominal penetrating trauma

INTRODUCTION: Thoracoabdominal penetrating injuries with a foreign body exiting to the other side are extremely rare, carry high morbidity and mortality. We encountered a case of thoracoabdominal penetrating injury with a long metallic pipe. AIM: Case report of penetrating thoracoabdominal injury with metallic pipe. METHODS Patient 24 years old, fall injury with penetrating thoracoabdominal trauma from metallic pipe. On initial assessment, the patient was talkative, with equal bilateral respiratory murmurs, hemodynamically normal, with a penetrating wound with a wedged metal, entry point (scaffolding segment) right lower thorax and an exit point beyond the left nipple. eFAST chest and pelvis xray were negative. The patient immediately underwent exploratory laparotomy and left thoracotomy, which were negative for injury. The metal stake was removed and chest tubes were placed bilateral. Computed tomography revealed bilateral pneumothorax, subcutaneous emphysema, air in the mediastinum, fractures of the 8th and 10-12th ribs on the right and the 8th rib on the left. During his hospitalization he developed pulmonary complications (pneumonia and cystic effusion) which were treated with percutaneous drainage under A/T and antibiotic treatment. He was discharged on the 40th postoperative day. RESULTS-CONCLUSION Initial management of the patient with an impaled object should follow ATLS principles. In a resource-limited setting, plain X-rays are valuable in surgery planning. Retained foreign bodies, especially those with sharp tips or edges, have to be dissected and removed with extra caution and meticulousness by a trauma surgeon in a controlled setting.