A Case of Suicide with Multiple Stab Wounds

Multiple stab wounds are very common features of homicidal stabbing.The common findings differentiating homicidal and suicidal stabbing are well described in the medical literature.Among the features mentioned are location,shape,and direction of the wounds.These features are vital in differentiating suicide from homicide.However,this case has an unusual presentation.We discuss the importance of interpretation and differentiation of the stab wounds to determine the manner of death and facilitate the investigation.A 29‑year‑old male presented with multiple stab wounds.There was no witness at the time of the incident.The body was discovered in his room with pools of blood.A knife was present on his body.No tentative cuts were present on the body.Scene investigation and postmortem examination determined the cause and manner of death.

Evaluation of follow-up and long-term outcomes of gunshot and stab wounds in a French civilian population

Purpose The data concerning long-term follow-up and outcomes of penetrating trauma are poorly detailed in the literature.The main objective of our study was to analyze the hospital and extra-hospital follow-up of penetrating trauma victims and to evaluate the late complications and long-term consequences of these traumas.Methods This work was a retrospective longitudinal monocentric observational study conducted at Laveran Military Hospital,from January 2007 to January 2017.All patients hospitalized for gunshot wound or stab wound management during this period were identified via a retrospective systematic query in the hospital information system using the ICD-10 codes.Epidemiological data,traumatism characteristics,hospital management,follow-up and traumatism consequences(i.e.,persistent disability)were analyzed.To improve evaluation of traumatism long-term consequences,extra-hospital follow-up data from general physicians(GP)were collected by phone call.During this interview,9 closed questions were asked to the GP.The survey evaluated:the date of the last consultation related to injury with the GP,the specific follow-up carried out by the GP,traumatism consequences,and recurrence of traumatism.Descriptive,univariate and multivariate with regression analysis were used for statistical analysis.Results A total number of 165 patients were included.Median(Q1,Q3)of hospital follow-up was 28(4,66)days.One hundred one patients(61.2%)went to their one-month consultation at hospital.GP follow-up was achieved for 76 patients(55.2%).Median(Q1,Q3)of GP follow-up was 47(21,75)months.Twenty-four patients(14.5%)have been totally lost to follow up.The overall follow-up identified 54 patients(32.7%)with long-term consequences,20 being psychiatric disorders and 30 organic injuries.Organic consequences were mainly peripheral nerve damages(n=20;12.1%).Most of the psychiatric consequences were diagnosed during GP follow-up(n=14;70%).Seventeen cases(10.3%)of recurrence were found and late mortality occurred in 4 patients(2.4%).High injury severity score,older age and gunshot wound were significantly linked to long-term consequences.Data collection and analysis were carried out in accordance with MR004 reference methodology.Conclusion This study showed a high rate of long-term consequences among patients managed for penetrating injury.If all organic lesions are diagnosed during hospital follow-up and jointly managed by hospital and extra-hospital physicians,most socio-psychiatric consequences were detected and followed by extra-hospital workers.However,for half of the patients,the extra-hospital follow-up could not be assessed.Thus,these consequences are very probably underestimated.It appears imperative to strengthen the compliance and adherence of these patients to the care network.Awareness and involvement of medical,paramedical teams and GP role seems essential to screen and manage these consequences.

About an Observation of a Child Penetrating Brain Injury by Knife

Background: Reported cases of knife injuries to the head in children are rare. Here we describe a case of pediatric penetrating brain injury by knife (PPBIK) and review literature. The patient’s parents were informed that non-identifying information from the case would be submitted for publication, and they provided consent. Case Presentation: A 3-year-old boy presented to our emergency department with a knife penetrating the front of his head during play. Neurologic examination was normal. Radiograph in lateral view demonstrated a metallic knife entering frontal bone. Computed tomography (CT) scan showed small hemorrhage around the foreign body recognized, accompanied by small pneumocephalus. The knife was surgically removed and the dura was closed. He was discharged home after the surgery with normal neurological status. Conclusion: Only four cases of PPBIK have been reported in the literature. The adequate management of these types of injuries requires a correct neuroradiological evaluation.

Aortoduodenal fistula following aortic reconstruction of a pseudoaneurysm caused by stab wound 12 years ago

Gastrointestinal bleeding due to aortoenteric fistula is extremely rare.Aortoenteric fistula is difficult to be diagnosed timely and entails a significant morbidity and mortality.Herein,we present an uncommon case of gastrointestinal bleeding caused by aortoduodenal fistula,which was a complication of a successful aortic reconstruction 4 months ago for an aortic pseudoaneurysm resulted from a stab wound 12 years ago.An urgent laparotomy confirmed an aortoduodenal fistula and repaired the defects in aorta and duodenum,but a prolonged shock led to the patient's death.In summary,early diagnosis and surgical intervention for aortoenteric fistula are vital for survival.

Transarterial coil embolization in treatment of gross hematuria following self-inflicted stab wound in a horseshoe kidney

Horseshoe kidney is an uncommon anomaly of the urinary system with an increased risk of injury during penetrating and blunt abdominal traumas. Selfinflicted abdominal stab wound, a rare type of abdominal injury, accounts for only a small percentage of suicidal attempts and may be infrequently encountered by physicians in trauma centers. Psychiatric disorders and alcohol or drug abuse are common risk factors in cases of self-stabbing. Here we report a rare case of self-stabbing of a horseshoe kidney. The case was a 19-year-old man with self-inflicted abdominal stab wound who was referred to our departmentof radiology due to re-occmTed gross hematuria three days after exploratory laparotomy and surgical repair of injured abdominal organs. A horseshoe kidney was incidentally found in the patient＇s abdominal computed tomography. Renal angiography revealed active contrast extravasation from one of the segmental arteries. Selective transarterial embolization with a coil was successfully performed to control the hematuria.

Thoracic injury:a review of 276 cases

Objective: Chest injury, one of the most important aspects of trauma, directly accounts for 25% of all traumarelated deaths and plays a major contributing role in another 25% of trauma deaths. This paper aimed to explore the spectrum and outcome of thoracic injuries seen in a multi centric study of trauma patients.Methods: A total of 276 consecutive trauma patients in 6 general hospitals were analyzed. The feature of injury,injury severity score (ISS), clinical treatment and mortality were recorded in a prospective manner and analyzed retrospectively. Multiple logistic regression analysis was used to determine the independent predictors of mortality following the chest trauma.Results: There were 246 males ( 89.1%) and 30 females (10.9% ) ranging from 3 to 80 years with a mean age of (34 ± 17) years. Road traffic accident was the main cause of injury, especially for pedestrians, followed by stab wound (89 cases, 32.1% ) and falling injuries (32 cases,11.6% ), respectively. Haemothorax or pneumothorax (50.4%) and rib fracture (38.6%) were the most common types of chest injury. Extremity fracture was the most common associated injury with the rate of 37% ( 85/230), followed by head injury (25.2% ) and abdominal trauma (19.6%). These injuries contributed significantly to the morbidity and mortality of trauma patients.Conclusions: According to the results, most patients with chest injury can be treated conservatively with close observation and tube thoracostomy. The presence of blunt trauma, head injury and abdominal injury independently adversely affect mortality after chest trauma. It is necessary to investigate the causes and patterns of injuries resulting from stab wound for effective prevention.

Dural arteriovenous fistulae after forehead knife-cut injury

Dural arteriovenous fistulae (DAVF) is a rare intracranial vascular disease. It is pathologically characterized by direct shunting of the intracranial artery and vein, which results in cerebral ischemia, intracranial hemorrhage, neural deficit and intracranial murmur. The etiological mechanism of DAVF is not well known, but most researchers think it is associated with congenital abnormal development, especially abnormal development of dural blood vessels at the stage of embryogenesis. Recently, some researchers have found that DAVF is also associated with some acquired factors. This article reports a case who developed DAVF within 2 years after debridement of frontal bone fragmentation, depressed fracture, left frontal lobe contusion and superior sagittal sinus injury due to forehead knife-cut injury. The pathogenic mechanism was explored through a review of the related literatures.

Emergent management of penetrating trauma of aortic arch in a countryside hospital

According to the literature, only a small proportion of occurrences regarding penetrating trauma of the thoracic aorta can be treated successfully. Herein we reported our experience of a recent rescue of such a patient in a countryside hospital lacking advanced instruments for cardiopulmonary bypass operations. A 20-year-old male was admitted for a penetrating injury with disrupted innominate vein and right common carotid artery together with a 1.5-cm laceration on the aortic arch between the innominate artery and the left common carotid artery. The patient was successfully saved without the implementation of cardiopulmonary bypass. Presentation and management in this case were discussed.