Surgical management of an abdominal impalement injury: A case report.

Abstract

Impalement injuries are a complex and rare type of penetrating abdominal trauma that happens when an object such as a post or a pole penetrates a person injuring several organs, making it a life-threatening situation in which time and correct management play an important part in the survival of the patient. A 37-year-old man suffered abdominal impalement injury with a metal signal post, penetrating the left flank of the abdomen. On examination, there is a hypoventilated left hemithorax with intercostal retractions, increased heart rate, weak distal pulses, delayed capillary refill, and pale skin. A 1-meter-long metal post (approximately 7cm diameter) penetrates the left flank with the entry in the posterior lumbar region.  Abdominal viscera, omentum, intestinal content, and ischemic loops of the small intestine are visible. An exploratory laparotomy was performed; left hemicolectomy, end colostomy and Hartmann procedure, resection of the affected jejunum, and end-to-end anastomosis were performed. On the ninth postoperative day, an abdominal tomography was performed due to the presence of fever peaks, which reported thrombosis of the left renal artery and emphysematous pyelonephritis, with the presence of a left pararenal collection. A simple left nephrectomy was performed. Postoperative surveillance was satisfactory during the following 5 days. The patient was discharged. An impaled injury is a complex lesion that needs special attention from the medical field for correct management. Although there is some literature about it, we encourage more research to be done about impalement injuries.