Diagnostic dilemma: A knife broke off in a man’s chest, and he didn’t notice it for 8 years
The patient: A 44 -year -old man in Tanzania
Symptoms: For 10 days, pus suited an opening in man’s chest under his right nipple, causing him to visit the emergencies. He told doctors that he had no pain or difficulty breathing. He had no fever and his vital signs were normal.
During the exam, the man reported that, eight years earlier, he had been stabbed several times in the chest, back, abdomen and face during a “violent altercation”. No imaging test was carried out at that time, and he received only a superficial treatment for the multiple knife injuries. For eight years, he had no health problems resulting from these injuries, he said.
The diagnosis: A radiography revealed a large blade of metal knife housed inside the man thoracic cavity. Also known as the thoracic cavity, this hollow room is located above the abdomen and contains the heart and the lungs. The blade, which extended from the back of the rib cage at the front, had entered the back of the man near his right shoulder blade or his shoulder blade.
The knife blade slipped between the fifth and sixth ribs on the patient’s back, then is glued there, with the tip of the knife positioned between the third and fourth ribs at the front of its rib cage. A computed tomography has shown fractures healed in its scapula and in several ribs. Settings of pus and dead or dying tissues surrounded the knife blade.
A way the body protects itself from foreign objects is by a process called Fibrous capsule trainingin which the Cocoons immune system the object in collagen and other fibers to limit damage and inflammation in the surrounding tissues. Such encapsulation of the knife is probably what allowed man to spend the next eight years without knowing that there was a blade inside his chest, according to the report.
Treatment: The hospital surgeons carried out a thoracotomy, in which they cut the chest wall of the man to remove the blade. They drained the accumulated pus, rinsed the thoracic cavity with a sodium chloride solution, installed a drainage tube and finally sutured the wound. The patient received broad spectrum antibiotics for seven days and was closely monitored for signs of infection after surgery.
The doctors withdrew the drainage tube after the eighth day and the man was released two days later. He returned to the hospital for two follow-up meetings: two weeks after his operation, and a six weeks later. During the two visits, he was without infection and did not know any other complications.
Which makes the case unique: After a traumatic thoracic injury, it is not uncommon for the part or the whole of the penetrating object to be left in the thoracic cavity. However, most of the time, these foreign bodies are small ballistic projectiles, such as bullets, which are often difficult to locate and remove.
In comparison, large bursts – for example, whole knife blades or other weapons of beady – which separate and loda in the chest are less commonly documented in the medical literature. And in most cases, these objects are not detected for years; They are generally identified and deleted in a few weeks or months, depending on the report.
This article is for information only and is not supposed to offer medical advice.
