PP 80 ‘IT CREPT UNDER MY SKIN’ SUBCUTANEOUS EMPHYSEMA FOLLOWING PENETRATING INJURY WITH DELAYED MEDICAL PRESENTATION

Abstract

INTRODUCTION

Penetrating injury should not be taken lightly and thorough investigation should be performed so as not to miss life-threatening conditions. We describe our patient who did not seek treatment immediately after having such injury.

CASE DESCRIPTION

A 13 years old boy with a history of alleged fall the day before in prone position while playing in the park came to our centre with the chief complaint of pain and wound over his abdomen. He claimed to have landed on a metal sharp object which pierced over the left abdomen. Patient earlier pulled out the object and went home, claiming only minimal bleeding. On examination, patient was comfortable with stable vital signs. There was a puncture wound over the left lumbar measuring 0.5 x 0.5cm, with subcutaneous emphysema extending up to the left hypochondriac region. Abdomen was soft and not tender. Lungs had equal air entry and no subcutaneous emphysema. No intraperitoneal free fluid on focused assessment with sonogram for trauma (FAST). CT Abdomen was done subsequently and showed skin and underlying muscle defect over the left side of abdomen resulting in subcutaneous emphysema. Nevertheless, there were no evidence of solid organ injury or perforated viscous. Patient was referred to the surgical team and wound debridement was done under general anaesthesia. Patient was well after operation and discharged 4 days later. 

CONCLUSION & LESSONS LEARNT

Any penetrating injury should be investigated fully. CT SCAN is helpful in being certain of injuries sustained. Public awareness is required so that patients would come to the hospital for thorough assessment so as to avoid life-threatening condition.