Two Cases of Penetrating Cardiac Injuries Caused by Stab Wounds

INTRODUCTION Selective non-operative management (SNOM) of abdominal stab wounds is well established in South Africa. SNOM reduces the morbidity associated with negative laparotomies while being safe. Despite steady advances in technology (including laparoscopy, computed tomography [CT] and point-of-care sonography), our approach has remained clinically driven. Assessments of financial implications are limited in the literature. The aim of this study was to review isolated penetrating abdominal trauma and analyse associated incurred expenses. METHODS Patients data across the Pietermaritzburg Metropolitan Trauma Service (PMTS) are captured prospectively into the regional electronic trauma registry. A bottom-up microcosting technique produced estimated average costs for our defined clinical protocols. RESULTS Between January 2012 and April 2015, 501 patients were treated for an isolated abdominal stab wound. Over one third (38%) were managed successfully with SNOM, 5% underwent a negative laparotomy and over half (57%) required a therapeutic laparotomy. Over five years, the PMTS can expect to spend a minimum of ZAR 20,479,800 (GBP 1,246,840) for isolated penetrating abdominal stab wounds alone. CONCLUSIONS Provided a stringent policy is followed, in carefully selected patients, SNOM is effective in detecting those who require further intervention. It minimises the risks associated with unnecessary surgical interventions. SNOM will continue to be clinically driven and promulgated in our environment.

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Suicide by more than 90 stab wounds including perforation of the skull

International Journal of Legal Medicine ◽

10.1007/s004140100244 ◽

2001 ◽

Vol 115 (3) ◽

pp. 167-169 ◽

Cited By ~ 29

Author(s):

B. Karger ◽

B. Vennemann

Keyword(s):

Stab Wounds

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STAB WOUNDS OF THE CHEST INVOLVING THE DIAPHRAGM

Journal of the American Medical Association ◽

10.1001/jama.1916.02590030020006 ◽

1916 ◽

Vol LXVII (3) ◽

pp. 178 ◽

Cited By ~ 1

Author(s):

CHARLES C. GREEN

Keyword(s):

Stab Wounds

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Stab Wounds at the Craniocervical Junction

Neurosurgery ◽

10.1227/00006123-198512000-00010 ◽

1985 ◽

Vol 17 (6) ◽

pp. 930-936 ◽

Cited By ~ 31

Author(s):

J.C. de Villiers ◽

A. R. Grant

Keyword(s):

Vertebral Artery ◽

Surgical Repair ◽

False Aneurysm ◽

Craniocervical Junction ◽

Artery Occlusion ◽

Cerebrospinal Fluid Leakage ◽

Warning Sign ◽

Upper Limbs ◽

Stab Wounds ◽

Anatomical Features

Abstract Between 1976 and 1984, 11 patients with stab wounds at the craniocervical junction were seen in the Department of Neurosurgery at Groote Schuur Hospital. The injury usually occurred in males, and the left side was predominantly involved. Because of the anatomical features of this region, the penetrating instrument is deflected by the occipital squama into the atlantooccipital or atlantoaxial interspace, and an almost predictable syndrome occurs. The dura mater is penetrated, so that cerebrospinal fluid leakage and meningitis are common complications (meningitis occurred in 5 patients). A meningocele may develop at this site and did occur in 4 patients, but only 2 required surgical repair. Because of the exposed position of the vertebral artery at this level, this vessel was injured in 4 patients; an arteriovenous fistula developed in 2, vertebral artery occlusion occurred in 1, and a false aneurysm developed in another patient. The neurological deficit varied in magnitude, was often transient, affected the upper limbs more than the lower, was asymmetrical (suggestive of lateralized injury), and at times showed a remarkable tendency to recover. Awareness of the existence of this syndrome may help in forestalling complications. The only warning sign may be an insignificant wound in the suboccipital or retromastoid region.

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