Raimundas Lunevicius,Adrian O’Sullivan.[J].Chin J Traumatol,2014,17(1):41-43. [doi]

Unusual management of thoracoabdominal impalement injury to the right hemiliver and diaphragm

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KeyWord: Thoracic injuries Abdominal injuries Wounds, penetrating

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Author Name	Affiliation
Raimundas Lunevicius	Cheshire and Merseyside Major Trauma Centre, Aintree University Hospital NHS Foundation Trust, Lower Lane, Liverpool L9 7AL, United Kingdom
Adrian O’Sullivan	King’s Major Trauma Centre, King’s College Hospital NHS Foundation Trust, King’s Health Partners, Denmark Hill, London SE5 9RS, United Kingdom

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Abstract:

Laparotomy or thoracolaparotomy is a traditional management approach for thoracoabdominal impalement injury associated with major liver and diaphragmatic injuries. We successfully treated the impalement injury with minimally invasive management. A male was brought to our trauma centre with the 15 cm long handle of the knife protruded from right lateral thoracoabdominal region. CT scan revealed that the knife blade traversed through the right costophrenic recess into segment 8 of the liver. There was an intraparenchymal haematoma and a collection of fluid in the abdominal cavity. The conservative management plan consisting of removing the impaled knife, observing, monitoring and managing complications was undertaken. A multidisciplinary approach to manage a patient with less invasive techniques yielded a good outcome. This management option may be considered as an alternative for open surgery for hemodynamically stable patients in experienced centres.

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