Saving the life of a victim stabbed through the waist and anus

A rare work accident case was recently saved by doctors at Saint Paul General Hospital (Hanoi). The patient was stabbed by a 2m long, 20mm diameter iron bar from the L4 lumbar region down to the perineum, through the anus.

Unprecedented case

Dr. Pham Van Khiet, Saint Paul General Hospital, said that the patient is a 34-year-old male, from Thanh Hoa, currently a laborer in Hanoi. At around 7:00 p.m. on November 30, 2015, the patient was taken to Saint Paul General Hospital by ambulance 115 in a state of shock due to pain, with an iron bar about 2 meters long and 20 mm in diameter piercing from the L4 lumbar region down to the perineum, through the anus.

Previously, according to the story, this young man was sitting on the first floor of a construction site when an iron bar fell from the fourth floor, causing serious injuries. After this rare accident, the patient was still conscious and was then taken to Saint Paul General Hospital for emergency treatment.

According to Dr. Khiet, through initial examination, the patient showed no signs of paralysis of the lower limbs, no signs of vascular damage. The X-ray results clearly showed the image of a foreign object penetrating from the waist down to the perineum. The patient was quickly taken for emergency surgery. The surgical team worked actively and urgently after more than 3 hours of surgery to save the patient's life.

X-ray images clearly show the iron bar piercing through the patient's perineum from the waist.

Dr. Nguyen Tat Thang, who directly performed surgery on this patient, said: “This is an unprecedented case. We performed surgery on the posterior sacral wall to remove the foreign object, sutured the rectal wound, and created an artificial anus for the patient. The surgery was long, and the process encountered many difficulties because the patient was always in a prone position. Not to mention the very complicated wound, extensive damage, and we suspected damage to many organs in the patient's body. With such an unprecedentedly severe injury, we predicted that the patient would have a hard time surviving, with a high risk of death. However, with the hope of saving the patient's life, "where there's life, there's hope", under the close direction of the hospital's leadership, we urgently consulted 5 specialties including: spine, digestion, urology, blood vessels, and neurology to come up with the optimal solution to save the patient's life."

Challenges in anesthesia and resuscitation

According to anesthesiologist Tran Nguyen Nhat, patients can easily fall into shock due to pain and blood loss. At this time, the patient is still in a state of panic due to pain and is not cooperating with the doctor.

The anesthesia team administered anesthesia to the patient.

"The prone position of the patient is very difficult for anesthesia preparation and resuscitation during surgery. Prone anesthesia is a real challenge for the anesthesiologist. Meanwhile, this patient was determined to have just eaten (full stomach), lying prone during anesthesia can cause vomiting to reflux into the airway, so the surgical team must discuss and consider carefully. The doctors urgently prepared the entire team. Prepared a plan for maximum anesthesia and resuscitation for all possible situations. Set up 2 peripheral veins of class G16. Blood tests and blood products of the same group immediately. The team decided to pre-anesthesia, good pain relief, deep sleep, active fluid and glue replacement... The decision was made to intubate in the prone position almost completely. Due to maximum preparation, the anesthesia process went smoothly. When the patient was stable, the doctors proceeded to make more large veins and actively resuscitate during surgery" - Dr. Nhat added.

It is worth mentioning that the surgical process was well controlled, so the patient's anesthesia and resuscitation became easier. After the surgery, because the patient had complicated injuries and was still in a high-risk condition, he was transferred to the Department of Surgical Intensive Care for intensive post-operative monitoring. The patient was extubated after surgery, recovered very quickly, and had good surgical progress.

From this case, doctors also recommend that people need to pay close attention to ensuring safety at work to avoid unfortunate accidents that are life-threatening.

According to SKDS