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Uneventful survival of a rural child after penetrating cardiac injury by a thorn: a case report.

ABSTRACT: Background:Paediatric penetrating cardiac injury is extremely rare, precluding published management guidelines, therefore warranting a case-by-case approach with learning points gleaned from each case. Case summary:A 7-year-old boy presented to a rural hospital with a stab wound to the chest by a Withaak (Vachellia tortilis) thorn. The patient was haemodynamically stable on presentation, but a 2?cm subcutaneous, pulsatile mass was present at the cardiac apex. Echocardiography revealed a foreign body penetrating from the apex into the heart, with evidence for a fistula between a cardiac chamber and the pulsatile mass. Angiography confirmed the existence of the fistula between the right ventricle (RV) and the pulsatile mass. A controlled extraction under general anaesthaesia via median sternotomy was performed in-theatre, with blood products and cardiac bypass on standby. The patient recovered without complications and was discharged after 4?days. Discussion:Our case illustrates the limitations of echocardiography in identifying the precise anatomical definition of penetrating cardiac injuries. Angiography is therefore indicated in such cases. The injury to the RV and the haemostatic effects of the in situ thorn were favourable prognostic factors. We believe that the mortality risk reduction of extraction under full control warrants the minor morbidity of a median sternotomy.

SUBMITTER: De Decker R

PROVIDER: S-EPMC6764539 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Uneventful survival of a rural child after penetrating cardiac injury by a thorn: a case report.

De Decker Rik R Li Yifan Joshua YJ von Delft Dirk D Meyer Heidi H Mureko Alfred A

European heart journal. Case reports 20190706 3

<h4>Background</h4>Paediatric penetrating cardiac injury is extremely rare, precluding published management guidelines, therefore warranting a case-by-case approach with learning points gleaned from each case.<h4>Case summary</h4>A 7-year-old boy presented to a rural hospital with a stab wound to the chest by a Withaak (<i>Vachellia tortilis</i>) thorn. The patient was haemodynamically stable on presentation, but a 2 cm subcutaneous, pulsatile mass was present at the cardiac apex. Echocardiograp ...[more]

PMID: 31660482

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Project description:BackgroundPenetrating thoracic injury is a type of critical illness with a high mortality rate, which often involves the heart, large blood vessels, and lungs. Penetrating cardiac injury is a very serious condition, and most patients die rapidly within minutes due to hemorrhagic shock and acute cardiac tamponade. Due to the critical condition and rapid development of this type of injury, most patients die before reaching the hospital. It is rare in clinical practice and difficult to treat.Case descriptionOur hospital recently admitted a case of penetrating cardiac injury. In this case, a 50-year-old male was admitted to the hospital following "a fall from a height [that] caused steel bar[s] to penetrate the chest cavity for 7 hours before he arrived at the hospital". The patient fell from a height of 3meters at a construction site, which caused 2 steel bars to penetrate his chest. The patient presented with symptoms such as chest pain, dyspnea, and apathy. Chest computed tomography suggested combined cardiopulmonary penetrating injury. Echocardiography suggested penetrating cardiac injury, and moderate pericardial effusion. After the patient was sent to the Emergency Department of our hospital, the relevant laboratory examinations and an emergency surgery were performed. The rescue team consisting of cardiac surgery, thoracic surgery, anesthesiology, emergency department, and imaging department specified the treatment plan. Under general anesthesia, cardiopulmonary bypass was performed via right femoral arteriovenous cannulation. The steel bars were removed, the left atrial posterior wall and ventricular septal perforation were repaired, and the great cardiac vein was sutured. Coronary artery bypass surgery was performed at the same time, and the anterolateral lung tissue of the left lower lobe was resected. Postoperative treatment was given to prevent against infection and improve cardiopulmonary function. The patient recovered well, and he was discharged from the hospital. The results of the follow-up 1 year after surgery were normal.ConclusionsTimely treatment and a reasonable operation mode is essential in treating this kind of trauma. A joint diagnosis and treatment by a multidisciplinary team can enable a comprehensive assessment of the condition to be made quickly and an optimal treatment plan to be formulated.

Project description:Introduction and Importance A stab or penetrating wound is one of the etiologies of chest trauma. In the case of penetrating chest trauma, assessment of probable major vascular injuries must be done. Thoracic, vascular injuries, in particular brachiocephalic rupture, require the surgeon to make swift decisions for repair as the wrong approach or incision could quickly lead to mortality. Case presentation Here, we report a case of a hemodynamically stable 9-year-old boy presenting with a stab wound by a fishing arrow. CT scan showed the fishing arrow projection at the suprasternal notch extended to the right hemithorax where the tip was near the brachiocephalic artery posterior wall. A sternotomy exploration and preservation of the proximal brachiocephalic artery, subclavian artery, and common carotid artery was done. We found a 0.5 cm rupture on the brachiocephalic truncus and performed a direct suture repair. Discussion Through this case, we present a vascular technique repair after the major thoracic artery rupture caused by a stab or penetrating wound. The principle of artery repair is to save the proximal and distal end of the ruptured artery, followed by a further safe and precise procedure. Conclusion The overall combination of approaches of chest trauma by a penetrating wound and vascular injury like brachiocephalic rupture without pseudoaneurysm or other asymptomatic high risks of vascular injury resulted in a satisfactory evaluation. In this case, leaving the arrow undisturbed is the key to the success of the first aid management before the patient is sent to the operating room. Highlights • Thoracic vascular injuries require swift decision-making as the wrong approach could quickly lead to mortality.• We present a hemodynamically stable 9-year-old boy with a fishing arrow stab wound on the right hemithorax.• Axial CT showed that the arrow was attached to the posterior wall of the brachiocephalic artery.• Sternotomy exploration was performed followed by direct vascular repair and release of the fishing arrow.

Project description:Introduction and importanceVulvar penetrating trauma is a rather uncommon occurrence (1). Firearm injuries caused by low-velocity gravitational bullets are a common cause of injuries in war-torn countries such as Somalia [2] (Campbell and Wilbert, 2022). These types of injuries are inflicted on by-standers by wayward bullets. No standard consensus on the appropriate management of vulvar penetrating trauma has been established (3). Here in, we report the successful management of an impacted bullet in the clitoris by a simple incision under local anesthesia. The principles of vulva and clitoris tired bullet trauma management are discussed. In our case, we thought it to be rare and interesting, considering its occurrence.Case presentationIn this report, a 24-year-old woman (gravida 2, para 2) suffered from a vulvar area penetrating bullet injury. Imaging revealed that the foreign body was confined to the clitoris, and no evidence of other parts of the body. Under local anesthesia, the bullet was accessed and removed from the clitoris by performing a minor incision. No complications were observed following the surgical removal of the bullet.Clinical discussionNon-obstetric vulva trauma is an extremely rare occurrence. Typically, the cause of non-obstetric vulvar trauma includes sports-related injuries, straddle injuries, and midline splitting injuries. To the best of our knowledge, this case is unique due to the bullet being retained in the clitoris. The treatment of the foreign body is mostly surgical removal. Under local anesthesia, this patient underwent complete surgical removal of the metallic foreign body. During surgical excision, care should be taken not to damage the urethra and other pelvic issues.ConclusionTo the best of our knowledge, this is the first wayward bullet (not intended for the patient) injury penetrating the vulvar area with a retained bullet in the clitoris. In our case, we thought it to be rare and interesting, considering its occurrence.

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Uneventful survival of a rural child after penetrating cardiac injury by a thorn: a case report.

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Uneventful survival of a rural child after penetrating cardiac injury by a thorn: a case report.

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