Abstract text (incl. references and figure legends)
Case history, clinical findings
A 28-year-old man, victim of unwitnessed aggression, is found in the prone position with multiple incisions in the dorsolumbar region, flanks and upper limbs and with an estimated blood loss of 2 liters.
Investigation/Results
He is admitted to the emergency room with a patent airway, eupneic, hemodynamically stable, tachycardic, GCS of 15, with decreased strength and sensitivity in the lower limbs.A bladed weapon was introduced in the dorsal region in a median position, with several other entry ports at the thoraco-dorsal level, right flank and left arm.
Diagnosis
Hemodynamic stabilization is performed. Thoracoabdominopelvic CT angiography reveals no apparent hemopneumothorax, hemopericardium or large-vessel involvement. No apparent pneumoperitoneum or free liquid. Liver and spleen without apparent lesions. A stab blade is observed at the level of the 8th dorsal vertebral body, with apparent medullary transection.
Therapy and Progressions
The patient is proposed for emergent stab removal with dural plasty, and for exploratory laparoscopy, which documented hepatic and diaphragmatic lacerations and transmural laceration of the small intestine. The wound on the upper limb had a significant section of muscle fibers with active arterial hemorrhage, which was ligated. The patient was later admitted to the intensive care unit for monitoring.
Comments
Traumatic spinal cord injury often occurs in patients with concurrent traumatic injuries in other body systems. These patients with polytrauma pose unique challenges to clinicians, since they encounter several issues that may affect several organs and that can go unnoticed in a primary evaluation.
References
Yue JK, Winkler EA, Rick JW, Deng H, Partow CP, Upadhyayula PS, Birk HS, Chan AK, Dhall SS. Update on critical care for acute spinal cord injury in the setting of polytrauma. Neurosurg Focus. 2017 Nov;43(5):E19. doi: 10.3171/2017.7.FOCUS17396. PMID: 29088951.
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