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Survival against anatomical odds: Management of a 143-cm transdiaphragmatic, transspinal rod impalement-A case report

Year: 2025

Type: article

Abstract: Impalement injuries are rare but often fatal injuries due to their complex nature involving multiple organ systems and the risk of massive hemorrhage. Patient outcome depends upon early resuscitation, the location, extent of organ involvement and post-operative care. We report a case of a 55-year-old man who fell onto an exposed rod from approximately 10 ft in height. On presentation to the Emergency Department in an ambulance, he was hemodynamically stable. He had absent sensory and motor functions below the T7-T8 levels of the trunk. Multiplanar CT showed rod impalement traversing the abdomen, thorax, and vertebral canal causing spinal cord transection, but without visceral/vascular injuries. He was taken to the operating theater, and laparotomy was performed, and the rod was extracted under direct vision. Post-operatively, he was managed with broad-spectrum antibiotics and supportive measures. He was discharged on the 8th post-operative day in stable condition. Patients with thoracoabdominal impalement should be managed in accordance with Advanced Trauma Life Support (ATLS) principles. Computed Tomography (CT) scan is the diagnostic modality of choice. Early hemodynamic stabilization followed by definitive removal in the operating room under direct vision is recommended. Meticulous postoperative care is crucial for optimal recovery. This report aims to emphasize that not all extensive impalement injuries lead to fatal outcomes. Prognosis depends on the mechanism of injury, resuscitation, management approach, and post-operative care. • A rare case of thoracoabdominal impalement by a 143 cm metallic rod traversing the abdomen, spine, and thorax, without injury to the major viscera or vessels. • The patient presented hemodynamically stable with complete spinal cord injury (ASIA-A) and was managed following ATLS principles. • Highlights importance of not removing impaled object outside the operating room. • Multiplanar contrast-enhanced CT was pivotal in defining the rod trajectory and proximity to vital structures. • Surgery involved extraction of the rod with repair of the mesenteric defect and placement of drains. • Early resuscitation, multidisciplinary coordination and postoperative vigilance led to favorable recovery.

Source: International Journal of Surgery Case Reports

DOI: 10.1016/j.ijscr.2025.112104

Authors: Suman Adhikari, Aashutosh Jha, Binod Bade Shrestha, Sushil Mishra, Mrigendra Raj Pandey, Pradeep Ghimire

Institution: Manipal College of Medical Sciences

Language: English

Topic: Trauma Management and Diagnosis

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,090