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Asian Cardiovasc Thorac Ann 2001;9:153-154
© 2001 Asia Publishing EXchange Pte Ltd

CASE STUDY

Chest Trauma Due to Impalement in a Fall

Kok Va Kei, MD, Chiang Tai Chow, MD

Department of Thoracic Surgery
Far Eastern Memorial Hospital
Taipei, Taiwan ROC
For reprint information contact: Kok Va Kei, MD Tel: 886 2 2351 1176 Fax: 886 2 2634 5393 email: kokvakei{at}ms29.hinet.net Division of Thoracic Surgery, Department of Surgery, Kang Ning General Hospital, 5th Floor, No. 17, Lane 12, Chin Tien Street, Taipei 106, Taiwan ROC.

   Abstract
TOP
 Abstract
Introduction
 Case Report
 Discussion
 References
 
A 17-year-old girl sustained impalement of the chest by a bamboo fence pole in a fall. She was rapidly transported to hospital while still impaled. The bamboo pole was successfully removed through a thoracotomy. Correct management at the scene and rapid transport were important factors in survival.


   Introduction
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 Abstract
 Introduction
Case Report
 Discussion
 References
 
Impalement wounds of the chest are uncommon in civilian life and only a few reports can be found in the literature.1–6 A case illustrating the factors that influence survival and the principles of surgical management, is described.


   Case Report
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 Abstract
 Introduction
 Case Report
Discussion
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A 17-year-old girl jumped from a 10th-story window in a suicide attempt. She landed on a bamboo fence and a pole of 6 cm in diameter impaled her through the right chest. She was revived after the tie of the bamboo fence was released. She was immediately brought to our hospital and arrived 20 minutes after the accident. On admission, she was in a state of stupor with tachypnea. The impaling pole was seen entering the chest laterally at the right midaxillary line just below the border of the breast (Figure 1Go). The patient's breathing was rapid and shallow with audible sucking sounds on inspiration. Her blood pressure was 100/60 mm Hg and her pulse rate was 128 beats per minute. The bamboo pole was sawn off in the emergency room, shortening it so that approximately 80 cm protruded from the chest. The patient was taken to the operating room without delay. The right chest was opened through a standard intercostal thoracotomy. There were multiple rib fractures as well as an extensive laceration and abrasions on the lateral aspect of the lower lobe of the right lung. The pole was found to have penetrated through the upper lobe of the right lung and it was lying against the pleural cavity. The foreign object was extracted (Figure 2Go) and a right upper lobectomy was performed. The fractured ribs were wired together and the right hemithorax was closed after insertion of 2 separate chest tubes. During the operation, 4 units of blood were transfused. Postoperatively, the patient was maintained on mechanical ventilation for 3 days and then gradually weaned off the respirator. She made a good recovery and was discharged 3 weeks later.



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  		Figure 1. Photograph demonstrating the entrance wound with the bamboo pole impaled in the right chest.

 


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  		Figure 2. The removed section of bamboo showing the bloody portion that had penetrated the upper lobe of the right lung.

 

   Discussion
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 Abstract
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 Case Report
 Discussion
References
 
An object penetrating the thorax, which remains in situ, must be stabilized to prevent further visceral damage. This is best accomplished with bulky dressings, towels, or blankets, secured with heavy tape. Generally, the position of the object should remain unchanged until the patient reaches the operating room. Open pneumothorax and massive intrathoracic bleeding are commonly fatal at the scene of an accident. Correct management at the scene and rapid transport of the patient to hospital is crucial for survival. These were achieved in the case described.

Assessment of the injury, resuscitation, and diagnostic measures should be kept to a minimum in the emergency room. In this case, preoperative chest radiography was technically impossible because of the length of the object impaled in the chest wall. Shortening of the object may be undertaken if necessary to facilitate transport and reduce the risk of unintentional dislodgment.

Debridement of the pleural space and excision of necrotic tissue should be accomplished during the initial procedure. Damaged vascular structures must be identified and controlled before the object is removed. Premature loss of tamponade following removal of the object is to be avoided, so a thoracotomy must be carried out to facilitate safe removal under direct vision of such a large foreign body. A right upper lobectomy was necessary to manage the bleeding problem in this case. The object had entered the right side and did not cross the mediastinum, which lessened the likelihood of further trauma to the heart and great vessels in this patient. Survival at the scene of the penetrating injury was also an important factor in the ultimate preservation of the life of this patient.


   References
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 Abstract
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  1. Romero LH, Nagamia HF, Lefemine AA, Foster ED, Wysocki JP, Berger RL, et al. Massive impalement wound of the chest. A case report. J Thorac Cardiovasc Surg 1978;75:832–5.[Abstract]

  2. Robicsek F, Daugherty HK, Stansfield AV. Massive chest trauma due to impalement. J Thorac Cardiovasc Surg 1984;87:634–6.[Abstract]

  3. Horowitz MD, Dove DB, Eismont FJ, Green BA. Impalement injuries. J Trauma 1985;25;914–6.[Medline]

  4. Hyde MR, Schmidt CA, Jacobson JG, Vyhmeister EE, Laughlin LL. Impalement injuries to the thorax as a result of motor vehicle accidents. Ann Thorac Surg 1987;43: 189–90.[Abstract]

  5. Okumori M, Futamura A, Tsukuura T, Konno S, Kuramochi K, Kaya S, et al. Impalement wounds of the head and chest by reinforced steel bars with recovery: an unusual case report. J Trauma 1981;21:240–1.[Medline]

  6. O'Leary ST, Waterworth P, Fountain SW. Multiple impalement injury: a remarkable survival. Injury 1996; 27:589–90.[Medline]





This Article
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