Abdominal and Thoracic Impalement Injuries in Children Due to Fall from Height: our Experience

Abstract

Impalement injuries are uncommon and are infrequently reported in the literature. Impalement injury in children is extremely rare. But fall from height are not uncommon in children and it is occasionally associated with major impalement injuries. These are complex surgical problems and the extent of injury depends on the tract traversed by the impaling object. The aim of this study is to focus on the extent of damage caused by impalement injury in children due to fall from height. Five cases of visceral impalement injuries in children were treated. Age of the patients ranged from 7 to 11 years. There were one female and four male patients. Modes of injury in all the cases were due to fall on projecting object: two cases due to fall from a tree and in three cases due to jumping into a pond. After initial resuscitation, all the cases were subjected to surgery. The tract of impalement, organs injured, treatment done, and outcome are analyzed. Route of entry of the impaling object was the anus in four cases and the umbilicus in one case. Impaling objects were extruded at the site of trauma in three cases and the objects were lying inside victim in two cases. The abdominal cavity was involved in two cases, and both abdomen and thorax were involved in three cases. The rectum or sigmoid colon were involved in four cases, small intestine in three cases, liver and diaphragm in three cases, and the right lung in three cases. A chest tube was inserted in three cases and colostomy was done in four cases. Hospital stay ranged from 11 to 27 days (mean 16.2 days). There was no mortality but morbidities were related to sepsis, tube thoracostomy, and colostomy. Impalement injuries are not uncommon in children. Injuries are usually complex and bizarre. Timely surgical intervention can save life but these are associated with significant morbidities.