Self-inflicted oral penetration injury: An intravenous drip pole advanced from the mouth to the retroperitoneum

• Oral penetration injury has risk of airway occlusion due to bleeding and edema.
• Prophylactic establishment of airway should be prepared.
• Emergency physician should coordinate with multidisciplinary team.
• Exploratory operation in case of hemodynamic and respiratory deterioration.

IntroductionPatients with oral penetration injuries require a systematic physical examination. These patients should be managed by a multidisciplinary medical team. Airway management, operative procedures, and transfusion needs of the patient with an oral penetration injury should be discussed before surgery.Presentation of caseA 63-year-old man with a history of recurrent hepatic duct cancer attempted suicide by advancing an intravenous pole through his mouth, neck, and thorax, ultimately penetrating into the right retroperitoneal space. A multidisciplinary team assembled by code blue emergently treated the patient, initially with fiberoptic intubation. The injured right lower lung was resected under one lung ventilation via a double lumen tube after tracheostomy. Fortunately, the pole did not injure any other organs or major vessels. Despite successful removal of the pole after lung resection, the patient died 14 days postoperatively due to his primary hepatic duct cancer.DiscussionWe highlight the need for a multidisciplinary approach to this patient’s management and discuss particular aspects of airway and transfusion management.ConclusionA systematic and multidisciplinary approach allowed successful removal of the drip pole and stabilization of the patient’s respiratory and hemodynamic status.