Open Penetrating External Laryngotracheal Injury and Abdominal Trauma by Suicide Attempt Successfully Treated With Immediate Intervention: A Case Report

Abstract

Background: An open penetrating external laryngotracheal injury (LTI) is a rare life-threatening injury requiring immediate intervention. Penetrating injuries may cause tissue loss, which makes wound closure difficult sometimes. Here, we report the case of a patient who developed an open penetrating external LTI and abdominal trauma by suicide attempt, which required surgical intervention.Case presentation: A 38-year-old Asian man with depression was found lying on the floor after cutting his neck and abdomen by himself. The emergency services found multiple deep lacerations on his anterior neck and abdomen. He was brought by a helicopter with a physician onboard to a regional trauma center and immediately intubated at the emergency department to secure his airway and prevent airway obstruction. On arrival, his blood pressure was 120/90 mmHg, and his heart rate was 120 beats/min. A pre-shock status was presumed, but other vital signs were normal. Physical examination revealed cut wounds (three lines on the neck and two lines on the abdomen) and no dysphonia. The patient was diagnosed with an open penetrating external LTI, classified as group 5 on the Schaefer classification system and zone Ⅱ on Roon and Christensen’s modification. He was also suspected with a mesenteric injury. We performed an emergency primary laryngotracheal repair and exploratory laparotomy. There was no obvious blood vessel injury, but soft and cartilage tissues were crushed and disconnected completely. On day 8, he underwent wound closure and tracheostomy on the caudal side of the wound. He was successfully weaned from mechanical ventilation on day 9, transferred to the general ward on day 13, decannulated on day 63, and discharged from the hospital thereafter for subacute care.Conclusions: This case was a severe neck injury with complete laryngotracheal separation, but tissue losses due to knife-stabbing were relatively minimal. Wound closure was presumed to occur early during primary repair, even though the purpose of primary repair was originally to secure the airway or manage blood vessel injury. Thus, in the absence of blood vessel injury, wound closure may occur early in patients who developed an open penetrating external LTI by suicide attempt.