Penetrating Neck Injuries Following a Case Report of a Successfully Healed Penetrating Neck Injuries Inflicted by a Sharp Tool

Abstract

Introduction: The penetrating neck injuries belong to the group of the most urgent conditions in medicine. Large blood vessels and nerves that connect the head with the body are situated in the neck as well as the important parts of respiratory and digestive system. The penetrating neck injuries inflicted by the sharp object cause damage to organs that are placed in the neck which directly treatens life of the injured person. Bleedings that occur in such conditions, as well as other complications, could be the immediate cause of death. Aim: The aim of our work is to present the case of a female patient with a penetrant and perforant neck injury and the state of the hemorrhagic shock, successfully treated in our institution. Case Report: Female patient, 37 years old, was injured by the two stabbs into the left side of the neck caused by kitchen knife. As the injury occurred 40 km from our center the first aid was administered at the regional center, so she arrived to our clinic already intubated, with heavy mouth bleeding despite tampooning of the mouth cavity, unconscious, with administered transfusion. Two sutured wounds were present on the  left lateral side of the neck, each about 2 cm long, one along the front SCM edge, localized in its middle third and the other placed laterally to the neck line, at about 2 cm below the left ramus of the lower jaw. She immediately underwent general anesthesia and the team work was organized to explore the above mentioned wounds. Two large injuries were noticed as dominant there: penetration of the internal jugular vein in the length of 3 cm and penetration of the lateral wall of hypopharinx. Primary vein wall plastic and hypopharynx reconstruction provided satisfactory haemostasis. The success of the intervention was checked by directoscopy. The nasogastric tube was immediately placed. In the postoperative period, the patient was extubated the following day, the nasogastric tube was removed after 7 days and there were no complica­tions detected. She was released home fully recovered on the tenth day. Discussion and Conclusion: The penetrant and perforant neck injuries belong to the group of the most urgent conditions in medicine since they directly threatens patient’s life. In taking care of these injuries, the most important thing is to secure breathing, by intubation or tracheotomy, to stop the bleeding, if not permanently, then at least temporarily, to provide for compensation of fluids by infusion or transfusion, as well as to organaize safe transport to the medical institution where patient can receive final treatment. The approach to such injuries requires team work, while being aware that the size of the entering wound does not implicate the size of the injury.