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.