Colossal thoracoabdominal impalement

Aguirre-Sánchez P.; Cabrera-Portilla W.; Ordóñez-Sullón C.; Rivera-Roncal A. · Revista Colombiana de Cirugia (2026) · DOI: 10.30944/20117582.2802

Resumen

Introduction. Impalement injuries are rare and those that occur in the thoracic region generally end up being fatal, due to injury to organs such as the heart, lungs and large vessels. Clinical case. We report the case of a 67-year-old man who suffered a traffic accident and was impaled by a large wooden beam, with nails embedded, in the left thoracoabdominal region. Results. A simultaneous exploratory laparotomy and left anterolateral thoracotomy were performed to remove the foreign body under direct vision. A grade I splenic injury, a large diaphragmatic injury, an injury to the lower lobe of the left lung, and comminuted fractures of the 5th to 8th anterior costal arches and the 7th to 10th posterior costal arches were identified. The patient underwent extensive lavage, suturing of the diaphragm and lung, redressing of the rib fractures, pleural drainage, and closure of cavities. The patient was transferred to the Intensive Care Unit (ICU) for antibiotic treatment, with favorable outcome. The patient was discharged with a recommendation for deferred chest wall reconstruction. Conclusions. These patients should be resuscitated with minimal manipulation of the impaled object and should be operated on without delay for further testing. The impaled object should be removed in the operating room, as it can cause massive hemorrhage or injure other structures when removed without direct vision. There is limited information and no protocol for those who suffer impalement, as reported cases are entirely anecdotal, with no uniform management.