Cardiac impalement injury by a steel rebar: A case report. (2020)

• Record Type: Journal Article
• Authors: Yoo, Byungsu; Shin, Yoon Cheol
• Is Part Of: International journal of surgery case reports. Volume 66(2020)
• Page Start: 174
• Page End: 177
• Publication Date: 2020
• Subjects: Cardiac injury -- Impalement -- Steel rebar -- Computed tomography; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2019.12.006
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Cardiac impalement injuries may be fatal. We report a patient with cardiac injury due to penetration by a steel rebar. The patient also sustained pulmonary injuries. The steel rebar was pulled out gradually during cardiopulmonary bypass (CPB). CPB is an effective surgical treatment even if there is a risk of bleeding. Abstract: Introduction: Penetrating cardiac injury often occurs in South Korea. However, impalement injury of the heart with other organs is rare and fatal. We present a case of cardiac impalement injury by a steel rebar. Presentation of case: A 38-year-old man was brought to the emergency room with a steel rebar of 45.5 cm in length in situ. Chest tomography revealed that the rebar had entered the thorax to the right diaphragm via the left shoulder while piercing the heart. The patient was immediately taken to the operating room for surgery without removing the bar. We were able to rescue the patient with an emergency operation wherein the bleeding site was treated by pulling the steel rebar out step-by-step while performing cardiopulmonary bypass. Discussion: Early diagnosis and rapid surgery are important factors for patients with cardiac impalement injury. Haemostasis must be achieved patiently step- by- step without removing the foreign object at once. CPB is an appropriate treatment, even if there is a risk of bleeding. Conclusion: This case highlights the importance of immediate surgical treatment for the survival of severe thoracic impalemant injury patients.