Conservative management of abdominoperineal impalement traum
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• A unique case report of a complex and serious abdominoperineal impalement injury that was successfully managed conservatively.

• Abdominoperineal injuries are mostly lethal, but those patients, who manage to reach hospital alive, usually need operative management and have a chance of survival.

• This case report presents, that even a serious impalement injury with penetration of the peritoneum can be managed conservatively, respecting that vital organs are not injured and the patients clinical status is closely observed.

Adult perineal impalement injuries are uncommon and notorious for their complex injury pattern and risk of massive pelvic bleeding. They present a challenge for the treating physician as there is no consensus about the optimal treatment in the existing literature. In most cases patients need operative intervention.

A 63-year old drug abuser on substitution therapy, presented to the emergency department with a painful stab wound in the left gluteal area. The patient was hemodynamically stable, there was no haematuria or blood around urethra and normal digital rectal exam. X-ray showed a 15 cm long blade, which travelled along the left pelvic wall. Computed tomography (CT) of abdomen showed, that the blade is in close proximity to the small bowel on the left middle side of the abdominal cavity. There were no signs of perforation or free fluid in the peritoneum. The foreign object was extracted manually in the emergency department operating room, it was a 15 cm long blade. The patient was admitted to the department of abdominal surgery for serial clinical assessments.

He received intravenous fluids, gentamicin and flucloxacillin and the tetanus injection. During the hospitalization he was hemodynamically stable, haemoglobin levels did not fall and inflammatory parameters were low, thus he was managed conservatively. Micturition and defecation were normal. After 7 days the patient was discharged from the hospital.