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CASE REPORT
Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 147-148

A woman with knife In situ of chest


Department of Emergency, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Date of Submission10-May-2020
Date of Decision30-May-2020
Date of Acceptance06-Jun-2020
Date of Web Publication22-Aug-2020

Correspondence Address:
Dr. Elnaz Vafadar Moradi
Department of Emergency Medicine, Imam Reza Hospital, Razi Sq., Mashhad
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/atr.atr_35_20

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  Abstract 


The violence can be physical, psychological or sexual. Physical violence can be by the use of sharp objects. Chest stab wounds with retained penetrating objects are rare. Here, we have reported a case with a knife impaled in her upper back who was treated successfully without any complications. A 35-year-old woman presented to our emergency department with an in situ knife at T4–T5 level. Neurologic examination revealed normal and bed side sonography reveals no free fluid in the abdomen, but lung sliding was disrupted on the left hemithorax without evidence of tamponade. A portable chest-x ray showed that the knife passes through an oblique track from right to left. The patient transferred to the operating room and the 50 cm knife removed without traumatic force. Limited thoracotomy with chest tube placement was done. We have reported a case report of an in situ knife at the upper back of a young woman who was successfully treated. The patient was stabbed in the upper back due to her husband's violence and the knife passes through an oblique track from right to left without any vascular injury. We stabilized the patient and used bedside sonography as a modality for diagnosis and decision making.

Keywords: Stab, violence, wound


How to cite this article:
Sadrzadeh SM, Kakhki BR, Moradi EV, Khosravi P. A woman with knife In situ of chest. Arch Trauma Res 2020;9:147-8

How to cite this URL:
Sadrzadeh SM, Kakhki BR, Moradi EV, Khosravi P. A woman with knife In situ of chest. Arch Trauma Res [serial online] 2020 [cited 2020 Oct 29];9:147-8. Available from: https://www.archtrauma.com/text.asp?2020/9/3/147/292956




  Introduction Top


Violence against women is one of the causes of psychological and physical injuries in them.[1] The Centers for Disease Control and prevention 2010 National Intimate partner reported 35.6% of intimate partner violence in women's over their lifetimes.[1] These violence can be physical, psychological or sexual, physical violence can be by the use of sharp objects.[1] Chest stab wounds with retained penetrating objects are rare.[2] Here, we have reported a case report of impaled knife in the upper back who was treated successfully without any complications.


  Case Report Top


A 35-year-old woman presented to our emergency department with multiple stab wound and an in situ knife at T4–T5 level. She told that her husbands stabbed her back when she tried to run away. At the time of admission, the blood pressure was 95/65 mmhg, the heart rate was 92 beats/min, the respiratory rate 24/min, and arterial oxygen saturation 94%. The physical examination revealed a 4 cm stab wound in the second cervical zone without crossing platysma and a 10-cm stab wound in the lateral aspect of the left forearm with evidence of tendon cut. A kitchen knife was seen in the upper back alongside of T4–T5 and the exact location of the tip could not be visualized. Neurologic examination revealed normal and bed side sonography reveals no free fluid in the abdomen, but lung sliding was disrupted on the left hemithorax without evidence of tamponade.

A portable chest X-ray showed that the knife passes through an oblique track from right to left [Figure 1]. The patient transferred to the operating room and the 50 cm knife removed without traumatic force. Limited thoracotomy with chest tube placement was done [Figure 2]. After vascular surgeon consultation, computed tomography angiogram was done which revealed normal. One week later, the left forearm tendons repaired successfully, the patient discharged home after 3 weeks with psychological consultation and without any complication.
Figure 1: Portal chest X-ray revealed the knife passes oblique track from right to left

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Figure 2: Postoperation chest X-ray with chest tube in the left hemithorax

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  Results and Discussion Top


Case of in situ knife injuries are rare in the literatures, here we have reported a case report of an in situ knife at the upper back of a young woman who was successfully treated. Novakov also reported similar case with thoracic stab wound as suicidal attempts. He was presented with impaled knife in the left hemithorax without pericardium penetration and he was treated without any fatal injury.[2] Our patients were stabbed in the upper back by her husband's violence and the knife passes through an oblique track from right to left without any vascular injury.

Agarwal et al. have reported a retained blade to the intramedullary spinal cord, who was treated successfully. Their patients have stabbed by serrated knife in the T11–T12 laminar bone.[3] Our patients stab wound was near T4–T5 space without insertion into the spinal space or spinal bone injury.

The removal of embedded knifes may lead to major bleeding and shock; so, they should remove in the operating room with direct visualization.[4] The assessment of other possible injuries should be considered in this patients.[2]


  Limitation and Conclusion Top


The case reports of thorax in-situ knife was rare, the aim of this report was to present a nonfatal chest stab wound with huge knife in situ. We stabilize the patient and used bedside sonography as a modality for the diagnosis of concurrent tamponade.

Consent

Before we prepared this manuscript, we informed the patient, and she gave informed consent to publish the manuscript without her name.

Declaration of patient consent

The authors certify that they have obtained all patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Acknowledgment

This study was performed with the moral support of the research deputy of Mashhad University of Medical Sciences.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Choo EK, Linden JA. Intimate partner violence and abuse. In: Swadron SP, Gruber PF, editors. Rosens Emergency Medicine. 9th ed. United State of America: Elsevier Companies; 2018. p. 758-65.  Back to cited text no. 1
    
2.
Novakov IP. Thoracic stab wound: A curious case report. Clin Surg 2018;3:2183.  Back to cited text no. 2
    
3.
Agarwal P, Burke JF, Abdullah KG, Piazza M, Smith BP, Thawani JP, et al. Stab wound to the intramedullary spinal cord: Presurgical and surgical management options for a retained blade to optimize neurological preservation. Surg Neurol Int 2016;7:S1096-8.  Back to cited text no. 3
    
4.
Meer M, Siddiqi A, Morkel JA, Janse van Rensburg P, Zafar S. Knife inflicted penetrating injuries of the maxillofacial region: A descriptive, record-based study. Injury 2010;41:77-81.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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Introduction
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