Discovery of a Glass Splinter in the Abdominal Cavity After an Old Impalement Injury: A Case Report and Literature Review

Abstract

Unusual clinical course Background:Intra-abdominal impalement injuries caused by a penetrating foreign body are rare and often fatal. The mechanism of injury is usually associated with vascular and organ damage, and the course is dynamic, with high morbidity and mortality. Post-traumatic presence of glass pieces in the peritoneal cavity after an old impalement injury is rare. Case Report:A 52-year-old woman sustained a 4-cm laceration in her lumbar region after falling on a glass table that shattered. After a physical examination and wound exploration in the emergency room, no foreign body was found.The laceration was sutured without X-ray imaging. She was admitted to the Surgical Department 9 months later for diagnosis of lower abdominal pain. In a CT scan of the abdominal cavity, a 19-cm fragment of glass was found intraperitoneally, inter-looped in the pelvic cavity. A laparotomy was performed, during which the foreign body was found and removed. No abdominal organs were injured. Further outpatient treatment was normal. Conclusions:Potentially minor abdominal impalement injuries can cause serious organ damage. Every patient, even if asymptomatic, and even after trivial injury with a small skin wound, must be suspected of having a hidden foreign body. Accurate visual, manual, and instrumental wound exploration is always necessary. Imaging exams are an important diagnostic method when the presence of a post-traumatic foreign body is suspected.

Foreign Glass Bodies in Pleura and Pancreas: Systematic Review for Entry Hypotheses and Treatment Options in an Unresolved Case

“…67 The few existing reports of glass impalement typically describe entry points that are either larger or, at the very least, no smaller than the smallest diameter of the shard. 5,7,59 This observation contrasts with our case where the glass shards entered through what seems to be a disproportionately small. Moreover, nonballistic penetrating injuries typically result in tissue disruption and/ or lacerations along the trajectory, and often manifest as radiologic findings such as subcutaneous air, hematoma, or even costal fractures and organ damage 68 ; such evidence was not found in our case.…”

“…The patient's inability to recall any earlier accident or injury lends some support to this theory. In principle, the mechanism of impalement by falling on a glass table or falling on glass was previously reported twice for intrathoracic 10,20 and 5 times for intra-abdominal 59,[61][62][63][64] shards. However, there are reasons to be cautious about this hypothesis.…”

“…54,65 In some cases, such severe vascular injury can even be fatal. 59 At the very least, minor pancreatic tears with a local inflammatory response would be inevitable. 84 However, the clinical presentation and radiologic findings in our case do not align with the more severe consequences that would typically result from a recent traumatic injury.…”

“…Other reported glass shards were typically located in the intraperitoneal space and became symptomatic after having been silent for months to nearly two years. [59][60][61][62][63] The retroperitoneal location may not follow the same pattern because it is less prone to movement by the bowel and other organs. Foreign bodies like bones in the pancreas often lead to abscess formation, adhesions, and pancreatitis over a short period, requiring laparoscopic or open surgery, sometimes even subtotal pancreatectomy (Table 3).…”

Glass table tops: An unusual source of lethal domestic injury

“…They all had occult glass shards removed that measured 19, 16 and 8.5 cm in length, respectively. [21][22][23] Thus, glass tabletops represent a rare but ongoing cause of death in domestic situations, and account for a much larger number of non-lethal injuries, particularly in children. These tables should not be used as a substitute for chairs, particularly in overweight individuals, as this provides yet another circumstance where obesity increases the risk of injury.…”