An unusual case of transpelvic impalement injury: A case-report

- Transpelvic impalement injury is a rare serious mechanical injury.
- The impaling object should be left in situ until the initiation of management at tertiary trauma center.
- Careful planning for removal of impaling object is crucial to minimize blood loss and preserve the involved organ function.
- Time is important when evaluating and resuscitating such patients.
- Treatment needs a multidisciplinary team with coordinated approach and early imaging studies.

IntroductionImpalement injury is a rare type of mechanical injury following forceful insertion of projecting object into the body. Careful planning for removal of the impaling object is essential to decrease the blood loss and preserve the function of the injured organ.Presentation of caseA 27 year-old male fell from 4 m height over a U shaped projecting up metallic bar. The bar penetrated the left side of the pelvis and traversed through the left iliac bone causing a comminuted fracture in the supra-acetabular region extending to the left psoas muscle, injuring the viscera and causing fracture of the right femur. Exploratory laparotomy was performed and the metallic bar was pulled out from the sigmoid colon through the inlet of the injury. Intramedullary nailing was performed for femur fracture. The patient developed infection (Methicillin-sensitive Staphylococcus aureus and Escherichia coli) during the post-operative course that was successfully managed with antibiotic therapy. Finally the patient was sent home after a week in a good health condition.DiscussionTwo surgical teams worked in sequence to fix the injuries starting with the trauma team followed by the orthopedic surgeons.ConclusionImpalement injury is a serious injury that needs a multidisciplinary team with a coordinated approach to achieve a favorable outcome.