Spectacular Retroperitoneal Impalement

Abstract

A 47-year-old woman presented with a history of an accidental fall against a glass door at home, causing a 15 cm-wide wound on the right gluteal region and hematuria. General health was good: blood pressure 115/70 mmHg with a heart rate of 100 beats/min; red cell count 4.460 x103/100 mL; hemoglobin concentration 10 g/100 ml; and hematocrit 31%. Computed tomography of the thorax and abdomen (Figure) showed the presence of a foreign body penetrating the right gluteal region and extending along the retroperitoneum. The object had passed across the entire longitudinal diameter of the right kidney. A concomitant retroperitoneal hematoma in the right perirenal space and pelvis was present. At emergency laparotomy a 25cm piece of glass was extracted from the gluteal wound after right nefrectomy and suture of a 2 cm laceration of the suprarenal inferior vena cava. The postoperative course was uneventful. Impalement injuries are rare and may occur either as a result of fall or collision of the human body against an immobile object or by means of a mobile object penetrating a stationary subject. They often pose particular challenges in surgical management. Mortality for penetrating abdominal vena cava injury is 36%–66%.1 Admission hypotension, suprarenal vena cava injuries and association with other visceral and/or other major vascular injuries are predictive of mortality.2