Abstract
We present the case of a 26-year-old patient who came to the emergency department for aggression with a puncture injury (ice picking) at the T12 thoracic vertebra.
Citation
Maza JM, Zamora MZ, Velásquez DAV and Benítez LC. Dorsal Spine Puncture Injury: A Surgical Challenge. SM J Orthop. 2017; 3(3): 1057
Clinical Summary
We present the case of a 26-year-old patient who came to the emergency department for aggression with a puncture injury (ice picking) at the T12 thoracic vertebra.
At his admission to the emergency department patient was hemodynamically stable without active bleeding signs
Patient had a puncture object with an entrance orifice at T12 level (Figure 1),
Figure 1: Sharp object in the dorsal region and its extraction
mobility and sensitivity of lower extremities were preserved. Abdominal tomography with evidence of a sharp object with an entrance adjacent to the vertebra with the distal end in contact with the medial wall of the inferior vena cava (Figure 2).
Figure 2: Tomography reconstruction with evidence of sharp object with lateral entry to the aorta and inferior vena cava.
Removal of pricking object in supine position on orthopedic table was performed making a midline laparotomy with evidence of stinging object in left lateral region of inferior vena cava without hematoma or active bleeding; extraction was performed with traction towards the dorsal region. He presented good postoperative evolution deciding his discharge on the third postoperative day
We present an infrequent case of puncture injury in the dorsal region. Although the object was found in this region, it was decided to perform exploratory laparotomy as there was a risk of injury to large vessels and at the time of removal of the object there was a risk of massive hemorrhage. The indicated management in such situation is to perform damage control surgery since correcting the hemorrhage in a controlled way can improve the chances of survival [1].
When an injury occurs in the inferior vena cava successful outcome depends on prompt volume restoration, a stratified selective management approach, and avoidance of hypothermia [2].
In the case of our patient, no repair maneuver was performed in the vena cava because there was no lesion or active bleeding.
No evidence supports the need to expose and repair vena caval wounds that have spontaneously stopped bleeding. Such wounds, especially in the retrohepatic area, may be managed expectantly [3].