Stab wounds cause injury to tissue in their path. Stab wounds to the chest, in addition to causing pneumothorax or hemothorax, may also cause life-threatening injuries to the heart and major blood vessels. One-quarter of anterior abdominal stab wounds do not penetrate the peritoneum. Half of those that do penetrate require no surgical intervention. For these reasons, local exploration, focused assessment with sonography for trauma (FAST), contrast-enhanced CT, and serial examinations are typical management strategies. Penetrating flank injuries are evaluated with contrast-enhanced CT. The size of the external wound frequently underestimates the internal injury. Impaled foreign bodies to the chest or abdomen pose a complex problem. The object inflicting the injury may also be preventing significant blood loss and therefore should be removed by the trauma surgeon in the operating room.
Impaled Chest Wound. This patient was stabbed in the chest with a butcher knife in a family dispute. The knife was stabilized by EMS providers at the scene and removed in the operating room. Injury was isolated to the right atrium. (Photo contributor: Kevin J. Knoop, MD, MS.)
Impaled Abdominal Foreign Body. Impaled knife to the left abdomen after a domestic argument. (Photo contributor: Ian D. Jones, MD.)
Management and Disposition
Initial management of the unstable patient with an impaled object includes crystalloid, blood, and oxygen administration; airway stabilization; and cardiovascular monitoring. Laboratory evaluation includes blood type and crossmatching, CBC, lactate, comprehensive metabolic panel, PT/INR, and urinalysis. Trauma team mobilization is an important step in the initial management of penetrating chest or abdominal trauma. Stabilization of the impaled foreign object should be performed to prevent further injury.
Impaled Nail in the Abdomen. Impaled 16-penny nail to the right abdomen after an accidental discharge from a pneumatic nail driver. The nail penetrated the peritoneal cavity but did not injure any organ. (Photo contributor: Lawrence B. Stack, MD.)
Impaled Chest Foreign Body. Impaled car window frame to the left chest causing rib fractures and a pulmonary laceration. (Photo contributor: R. Jason Thurman, MD.)
Impaled chest or abdominal foreign bodies should be removed only by a trauma surgeon in a controlled setting.
Seeing the size, shape, and trajectory of the impaled foreign body gives the trauma team clues to injured structures, which is another reason to leave the impaled object in place when possible.