A rare case of penetrating splenic injury caused by assault with a large fishbone

Auhtor: T Talukdar, MJK Bhuiyan, MN Islam, UT Kyow, Ahmadullah

Abstract:

Background: In subcontinent countries including Bangladesh, abdominal injury due to physical assault is not very uncommon scenario. Mostly penetrating injury is due to stabbing or gunshot injury. But we aim to present a rare case of penetrating splenic injury with large fishbone following history of assault. Case report: A 45 years day labourer male patient came from Cox’s bazaar, Bangladesh and admitted (05.04.2016) to surgery inpatient department of Cox’s Bazar Medical College Hospital with the history of physical assault by the neighbour with a long sharp object over left lower chest and severe pain with bleeding from the injured site for five hours. On examination patient was apprehended, anxious moderately anaemic, tachycardic (pulse 109 b/min), hypotensive (90/60 mm of Hg). Part of foreignbody was seen at left lower chest that penetrate the abdominal cavity, bleeding was also seen from the injured site. After admission assessment and resuscitation were gone simultaneously. After that, patient was investigated accordingly. Ultrasonography findings were foreign body within the spleen and mild pelvic collection. With proper counseling and consent we underwent exploratory laparotomy under general anaesthesia. A foreign body (fishbone) was identified that penetrate the spleen through and through. Small peritoneal collection (blood) was also seen. After removing of foreign body spleen was repaired and peritoneal toileting done. Patient was closely monitored for rebleeding but he was recovered well and discharged from hospital after removal of stitches. Conclusion: Although trauma resulting from road traffic accidents remains the most common cause of splenic injuries but the incidence of penetrating injuries to the spleen is also on rise in civil society day by day in developing countries. Increasing awareness about the risk of overwhelming post-splenectomy sepsis and postoperative complications are major incentives for splenic salvage and non-operative management.

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