Pediatric penetrating thoraco-abdominal trauma

Case contributed by Dr Rodney Strahan

Presentation

Brought to hospital following spear attack on mother. Metal spear missed the mother but entered the child on her back.

Patient Data

Age: 1 year
Gender: Female

Metal spear has entered the child's right chest and continued though the diaphragm and abdomen, exiting the left lateral abdomen.

Large right pneumothorax with mediastinal shift to the left and herniation of right lung across the midline.

Lateral projection (with horizontal beam) confirms the abdomen is involved and there is a small amount of free gas beneath the diaphragm and anterior abdominal wall, indicating perforation of a hollow viscus.

Following instigation of treatment -

1. An endotracheal tube is just above the carina. Nasogastric tube in situ.

2. Pneumothorax has largely resolved and the mediastinum normalized, however the right intercostal tube is now in the chest wall.

3. Increasing intra-abdominal gas with Rigler's sign: both sides of the bowel wall outlined by intraluminal and extraluminal gas.

Case Discussion

This is a very unfortunate case, especially as it involved an accidental injury to the child, which did not survive.

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