Emergency surgery for penetrating neck trauma and common carotid artery laceration presenting with shock: a case report

Abstract

Introduction: The neck is an important anatomical junction connecting the head and limbs to the trunk and several vital neurovascular and aerodigestive structures pass through it. Zone II is the commonest site of penetrating neck injuries (PNI) and is commonly associated with vascular injury. The mortality rate following PNI is approximately 10%, increasing to 20% with concomitant penetrating carotid injury. Case description: A 43-year-old was brough to the emergency department in class III haemorrhagic shock with a 5mm, bleeding, penetrating neck injury in zone II of the neck. He had soft signs of vascular injury, bleeding was controlled with direct pressure, and resuscitation was commenced with intravenous crystalloids and blood products. Surgical exploration revealed a 5mm laceration in the distal common carotid artery which was repaired primarily. Postoperative computed tomography (CT) angiogram was normal and the patient had an uneventful recovery. Discussion: Traumatic disruption of the platysma is described as PNI and accounts for 10% of all penetrating injuries. Vascular injuries are most commonly seen in zone II and are usually associated with hard and soft signs of vascular injury. Zone II injuries require operative exploration with preoperative CT angiography recommended in haemodynamically stable patients to identify the type of injury. Small defects in the carotid artery can be repaired primarily. Conclusions: Open surgical exploration is mandatory for all patients with penetrative neck injury and haemodynamic instability. CT angiogram is recommended prior to open exploration is stable patients with zone II PNI.