A case report of rescue in extremis of mediastinal impalement: more fear than harm

Abstract

: Mediastinal impalement by a sharp object is both an extraordinary and fortunately exceptional situation. The cases are infrequently encountered and rarely report in literature because the majority of these patients die in pre-hospital care. In the literature, only a few cases have been published to date. A review of the literature reveals that most patients with mediastinal impalement do not survive or have an unpredictable injury pattern. In this presentation, the authors report a strange case of attempted homicide in the context of family vindictiveness with a sharp knife of a 58-year-old woman was reported. The surgical exploration was chosen, allowing good exposure of the object but no visceral or vascular lesions were observed. The marking hazard we encountered with this observation was that the innominate artery passed through the hole in the tail of the knife, which was already broken at the lower edge without causing any damage to the vessel. Perioperative management may involve multiple surgeons performing simultaneous surgical procedures. The removal of the intra-mediastinal knife is a delicate process that requires a careful etiopathogenic analysis of the victim and the intrathoracic impaled object to prevent other damages to the patient. The authors describe an unexpected non-fatal of penetrating intra-mediastinal injury and via a literature review, the tricks and tips of surgical management are discussed in a stable patient.