PDF(Pubmed)
Abstract：
Impalement injuries are rare and complex problems, often involving multiple organ injuries. An 18-year-old male was admitted to our emergency department after a car accident. Positioned in the right-side recumbent position, he had a 4.5 cm diameter pipe penetrating from his left abdomen to his back. Given the pipe\'s length exceeding the CT gantry\'s capacity, further imaging tests were not feasible. Consequently, the patient proceeded directly to the operating room without preoperative imaging. Before laparotomy, a left thoracotomy was conducted for aortic cross-clamping, anticipating uncontrollable bleeding during pipe removal. The subsequent laparotomy, with the patient in the right-side recumbent position, revealed the pipe impaling through the mesentery of the descending colon without evident major vessel injury. The pipe was cautiously extracted. The patient was subsequently discharged on day 26. The absence of imaging feasibility emphasized that current hemodynamic stability does not rule out the potential for significant vessel injury. Therefore, the sequential approach of left thoracotomy for aortic cross-clamping followed by laparotomy emerges as a potentially beneficial strategy in cases of transabdominal impalement. The impalement injury requires our preparedness and flexibility, which should be tailored to the individual case.
摘要：
外伤是罕见且复杂的问题，经常涉及多器官损伤。一名18岁的男性在一场车祸后被送进了我们的急诊室。定位在右侧卧位,他的左腹部有一条4.5厘米直径的管道穿透到背部。鉴于管道的长度超过CT台架的容量，进一步的影像学检查不可行.因此,患者在没有术前成像的情况下直接进入手术室.剖腹手术前,进行了左开胸手术以进行主动脉交叉钳夹术，预计管道拆除过程中不可控的出血。随后的剖腹手术,患者处于右侧卧位，发现管道刺穿了降结肠的肠系膜，没有明显的大血管损伤。管子被小心翼翼地抽出。患者随后在第26天出院。缺乏成像可行性强调了当前的血液动力学稳定性并不排除严重血管损伤的可能性。因此,在经腹穿刺的病例中,左侧开胸手术行主动脉交叉钳夹术,然后进行剖腹手术是一种潜在的有益策略.刺穿伤害需要我们的准备和灵活性，这应该是针对个别情况的。
