Open Access Open Badges Case report

Thoraco- abdominal impalement injury: a case report

Gyanendra Malla1, Bibhusan Basnet1*, Rais Vohra2, Casey Herrforth3, Shailesh Adhikari4 and Amit Bhandari1

Author Affiliations

1 Department of General practice and Emergency Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal

2 Department of Emergency Medicine, UCSF Fresno Medical Center, Fresno, CA, USA

3 Department of Emergency Medicine, UC Health, Emergency Medicine, CO, USA

4 Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal

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BMC Emergency Medicine 2014, 14:7  doi:10.1186/1471-227X-14-7

Published: 4 March 2014



Impalement injury is an uncommon presentation in the emergency department (ED), and penetrating thoraco-abdominal injuries demand immediate life-saving measures and prompt care. Massive penetrating trauma by impalement in a pediatric case represents a particularly challenging presentation for emergency providers in non-trauma center settings.

Case presentation

We report a case of 10 year old male who presented in our ED with an alleged history of fall from an approximately 15 foot tall coconut tree, landing over an upright bamboo stake approximately 50 centimeter long, resulting in a trans-abdomino, trans-thoracic injury. In addition to prompt resuscitation and hospital transfer, assessment of damage to vital structures in conjunction with surgical specialty consultation was an immediate goal.


This article describes a case study of an impalement injury, relevant review of the available literature, and highlights the peculiar strategies required in the setting of a resource limited ED.

Nepal; Trauma; Emergency medicine; Trauma surgery; Rural emergency medicine