Management of penetrating thoracic injury sustained during a mountain-biking accident

Abstract

Trauma is a common phenomenon in South Africa, with a large proportion of patients suffering from penetrating chest injuries. Occasionally atypical penetrating thoracic injuries require surgical intervention with special considerations. We describe the management of a 15-year-old boy who presented to our trauma unit with a large diameter branch penetrating his left chest above the left clavicle and with the tip lodged in the mediastinum between the great vessels. Pulsatile movement of the foreign body was clearly visible and required careful consideration for the optimal approach and possible complications that may arise. The tract and location of the foreign body made the approach and management of this patient unique and a valuable learning opportunity. A high lateral thoracotomy was done, and the object removed under direct vision. It yielded excellent exposure and proved to be a good alternative approach for certain atypical cases. The boy made a full recovery with no long-term complications.