IAR Journal of Medical Case Reports ISSN Print : 2709-3220 | ISSN Online : 2709-3239 Frequency : Bi-Monthly Language : English Origin : Kenya Website : https://www.iarconsortium.org/journal-info/iarjmcr Available: https://iarconsortium.org/journal-info/iarjmcr 27 Penetrating Thoracoabdominal Injuries from an Iron Fence: Case Report and Literature Review Abstract: Penetrating injuries through the abdomen and thorax have a higher impact on morbidity and mortality than injuries inside one of them. Resuscitation and Handling properly in early stages will bring good results to the patient. Keywords: injuries, thoracotomy, laparotomy, penetrating, iron fence, thorax- abdominal, liver. INTRODUCTION Penetrating injuries through the abdomen and thorax have a higher impact on morbidity and mortality than injuries inside one of them. Foreign objects that enter the body cavities should not be detached prior the patient’s arrival in the operating room (Muchuweti, D., & Muguti, E. 2020). Trauma is the third most prevalent cause of mortality after cardiovascular disease and cancer and the leading cause of mortality in patients under 40 years old (Petrowsky, H. et al., 2012). Injury of the abdomen is an usual cause of death, accounting for 7-10% of trauma patients. The condition will depend on injured organs and hemodynamic stability (Johnson, J. J. et al., 2013). Presentation of penetrating abdominal and chest trauma can provide clinical features of pneumohemothorax, hemothorax, cardiac tamponade, pneumothorax, airway obstruction, and pulmonary contusion (Shanmuganathan, K., & Matsumoto, J. 2006). Penetrating abdominal injuries can be extended to the intrathoracic organ, which may present with massive hemoperitoneum due to the mesentery injury, gaster, spleen, liver, or peritonitis from bowel perforations. Abdominal stab wounds usually affect hollow viscus organs (Biffl, W. L., & Moore, E. E. 2010). Foreign bodies that stab intra- abdominal or chest have a tampon effect, and attempts to remove them before surgery increase the severity and risk of death. ( McDonald, A. A. et al., 2018). A total of 1359 patients from 2004 study with traumatic injury of the chest at a United States level I trauma center figured that only 18% of patients needed tube thoracostomy and 2.6% required advanced thoracotomy ( Shanmuganathan, K., & Matsumoto, J. 2006). The severe injury cases happened from blunt trauma, and the overall death was 9.45%. Immediate thoracotomy and laparotomy are essential for managing double cavity injuries and retrieving foreign materials (DeBarros, M., & Martin, M. J. 2015). ILLUSTRATION Four hours before admission to the hospital, while a 24 years old Mr. H was repairing the roof of the house by climbing over the fence, the patient suddenly lost his balance and then slipped from the roof. The patient fell with his chest position of the lower right abdomen stuck at the end of the open gate in a standing position. The others were released by lifting the patient's body from the bottom up. After being released from the entrance, one end of the fence was broken and allegedly left inside the patient's body. After the incident, the patient complained of abdominal and chest pain. The patient was immediately taken to Sukoharjo District Hospital by rescue workers, put on IV lines, stitched up the wound, injected with analgetic, and did a chest X-ray. Parts of the iron fence were left in the stomach and chest. Because of this condition, the patient must get an assessment and intervention of the thoracic and digestive in Dr. Moewardi Surakarta Hospital. Case Report Article History Received: 20.07.2021 Revision: 31.07.2021 Accepted: 10.08.2021 Published: 20.08.2021 Author Details Imam Hafidh Zaini *1 , Pigur Agus Marwanto 1 , Agus Raharjo 2 and Arif Prasetyo Utomo 3 Authors Affiliations 1 General Surgery Resident Faculty of Medicine, Sebelas Maret University, Indonesia 2 Digestive Division, Surgery Department, Faculty of Medicine, Sebelas Maret University, Indonesia 3 Thoracic and Cardiovascular Division, Surgery Department, Faculty of Medicine, Sebelas Maret University, Indonesia Corresponding Author* Imam Hafidh Zaini How to Cite the Article: Imam Hafidh Zaini, Pigur Agus Marwanto, Agus Raharjo, & Arif Prasetyo Utomo. (2021); Penetrating Thoracoabdominal Injuries from an Iron Fence: Case Report and Literature Review. IAR J Med Cse Rep. 2(4), 27-33. Copyright @ 2021: This is an open-access article distributed under the terms of the Creative Commons Attribution license which permits unrestricted use, distribution, and reproduction in any medium for non commercial use (NonCommercial, or CC-BY-NC) provided the original author and source are credited. DOI: 10.47310/iarjmcr.2021.v02i04.007
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IAR Journal of Medical Case Reports ISSN Print : 2709-3220 | ISSN Online : 2709-3239 Frequency : Bi-Monthly Language : English Origin : Kenya Website : https://www.iarconsortium.org/journal-info/iarjmcr
airway obstruction, and pulmonary contusion (Shanmuganathan, K., &
Matsumoto, J. 2006).
Penetrating abdominal injuries can be extended to the intrathoracic
organ, which may present with massive hemoperitoneum due to the
mesentery injury, gaster, spleen, liver, or peritonitis from bowel
perforations. Abdominal stab wounds usually affect hollow viscus organs
(Biffl, W. L., & Moore, E. E. 2010). Foreign bodies that stab intra-
abdominal or chest have a tampon effect, and attempts to remove them
before surgery increase the severity and risk of death. (McDonald, A. A.
et al., 2018).
A total of 1359 patients from 2004 study with traumatic injury of the chest at a United States level I trauma center
figured that only 18% of patients needed tube thoracostomy and 2.6% required advanced thoracotomy (Shanmuganathan,
K., & Matsumoto, J. 2006). The severe injury cases happened from blunt trauma, and the overall death was 9.45%.
Immediate thoracotomy and laparotomy are essential for managing double cavity injuries and retrieving foreign materials
(DeBarros, M., & Martin, M. J. 2015).
ILLUSTRATION
Four hours before admission to the hospital, while a 24 years old Mr. H was repairing the roof of the house by
climbing over the fence, the patient suddenly lost his balance and then slipped from the roof. The patient fell with his
chest position of the lower right abdomen stuck at the end of the open gate in a standing position. The others were
released by lifting the patient's body from the bottom up. After being released from the entrance, one end of the fence
was broken and allegedly left inside the patient's body. After the incident, the patient complained of abdominal and chest
pain. The patient was immediately taken to Sukoharjo District Hospital by rescue workers, put on IV lines, stitched up
the wound, injected with analgetic, and did a chest X-ray. Parts of the iron fence were left in the stomach and chest.
Because of this condition, the patient must get an assessment and intervention of the thoracic and digestive in Dr.
Moewardi Surakarta Hospital.
Case Report
Article History
Received: 20.07.2021
Revision: 31.07.2021
Accepted: 10.08.2021
Published: 20.08.2021
Author Details Imam Hafidh Zaini*1, Pigur Agus Marwanto1,
Agus Raharjo2 and Arif Prasetyo Utomo3
Authors Affiliations 1General Surgery Resident Faculty of
Medicine, Sebelas Maret University, Indonesia 2Digestive Division, Surgery Department,
Faculty of Medicine, Sebelas Maret
University, Indonesia 3Thoracic and Cardiovascular Division,
Surgery Department, Faculty of Medicine,
Sebelas Maret University, Indonesia
Corresponding Author* Imam Hafidh Zaini
How to Cite the Article: Imam Hafidh Zaini, Pigur Agus Marwanto,
Agus Raharjo, & Arif Prasetyo Utomo.
(2021); Penetrating Thoracoabdominal
Injuries from an Iron Fence: Case Report and
Literature Review. IAR J Med Cse Rep. 2(4),
27-33.
Copyright @ 2021: This is an open-access article distributed under the terms of the Creative Commons Attribution license which permits unrestricted use, distribution, and reproduction in any medium for non commercial use (NonCommercial, or CC-BY-NC) provided the original author and source are credited.
DOI: 10.47310/iarjmcr.2021.v02i04.007
Imam Hafidh Zaini, et al., IAR J Med Cse Rep; Vol-2, Iss- 4 (July-Aug, 2021): 27-33
28
The patient was a healthy young male with stable
hemodynamic. No sign of anemia and cyanosis in
mucous membranes were found. His blood pressure was
130/80 mmHg, pulse was 108 beats per minute, and
respiratory rate was 28 breaths per minute. Oxygen
saturation level on free air was 94%. Chest examination
showed breathing from the left chest was higher than
the right one. The laceration was sutured with 3.0
nonabsorbable multifilament thread at midaxillary line
sixth intercostal and abdominal above the right inguinal
line. Physical examination revealed lacerations in the
chest and lower right abdomen. On percussion, lung
sounds dim at the level of 5-8 ribs.
(a) (b)
Figure 1. Picture of patient in the emergency room before operating surgery (a) front view and (b) right side view
The patient was given oxygen 10 liters per minute
with a non-rebreathing mask, ringer lactate infusion,
human tetanus immunoglobulin injection 250 UI, and
ampicillin injection 1 g every 8 hours. Breathing
clearance with chest tube placement on the right chest
was performed, produced 300 ml of blood. Before
entering the operation room, the blood production rate
was 200 ml per hour. A nasogastric tube (NGT) was
inserted to drained the bleeding and removed
exaggerated gas from the intra-abdominal cavity. A
transurethral catheter was placed for urine output