A non-lethal left sided thoracic impalement injury: A case report.

INTRODUCTION AND IMPORTANCE: Impalement injuries are those injuries that result from the injuring object or weapon being stuck on to the victim's body parts. Such cases occur rarely and when they do they pose a great challenge starting from transportation to anesthesia induction and surgical decision. The extremities are the commonest parts of the body where this occurs. Only a few reports of thoracic impalement injuries have been documented in the literature.

CASE PRESENTATION: Here we present a case of a 25 years old male patient who presented 36 hours after sustaining an impalement injury to his left chest by a metallic spear. He was explored via a left posterolateral thoracotomy incision and the spear was removed under direct vision successfully.

CLINICAL DISCUSSION: Thoracic impalement injuries occur very rarely in the civilian setting. The most important pillar in the management of such injuries is to avoid any manipulation of the impaled object outside of an operation theater where it's done under direct vision in a controlled manner. Post-operative care includes tube thoracostomy, antibiotics and chest physiotherapy and the other components of the enhanced recovery after surgery protocol components.

CONCLUSION: Thoracic impalements are extremely uncommon, as are impalement injuries in general. When they do occur, multidisciplinary teams-primarily the surgeon, anesthesiologists, and emergency physicians. Early cardiothoracic consultation and avoiding manipulation of the impaled object by all means necessary outside of operating room along with the standard advanced trauma life support principles are cornerstones in the management of this patients.