CASE DESCRIPTION:
A 28 year male walked into the emergency room with an alleged history of
a fight an hour back and was attacked with a weapon, a home-made knife,
which was still lodged into the back of the patient in the midline with
minimal bleed from the entry point. (Figure 1 ) He gave a
positive history for alcohol consumption the same day with mild
intoxication. He did have some abrasions and bruising to his upper torso
and complained of pain and tenderness in the area of the lodged weapon
with no active bleed.
In the emergency room ATLS guidelines were followed where the airway,
breathing and circulation where intact and normal. The patient was
comprehensible with a GCS of 15/15 and all neurological facilities
intact. A secondary survey did not reveal any other significant injuries
to the body. Initial plain X-Rays demonstrated a triangular opaque
shadow at a depth of 5-7 cms into the body at the level of
8th -9th dorsal vertebrae close to
the midline with no fracture. (Figure 2 ) Since the patient’s
neurological survey, the spinal cord and the vertebrae was intact and
after discussion with the radiologist it was established that there was
no injury to it. A USG scan was done to evaluate with no positive
finding in the back region nor in the abdomen.
He was taken into the operation theatre and under general anesthesia,
the patient was placed in prone position and the stab site was explored
and the knife extracted. (Figure 3 ) The home-made knife was
lodged 6 cms deep into the body lodges in the muscles and next to the
8th- 9th vertebrae. There was no
injury to any vertebrae or to the major vascular structures and organs.
(Figure 4 ) The knife seemed to have deflected off the spinous
and transverse processes of the dorsal vertebrae, which to the luck of
the patient saved any major and devastating injuries. The wound was
closed in layers and the patient was shifted to the ward. The patient
was discharged on 2nd post-operative day and he is on
regular follow-up for the last 5 months and is asymptomatic and healthy.