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Anatomy of a Suicide: A Case Report.
Am J Case Rep 2019; 20:1801-1804AJ

Abstract

<strong>

BACKGROUND

</strong> Penetrating neck injuries (PNI) have a relatively low incidence constituting just 1.6% to 3.0% of overall suicide attempts. Nonetheless, the anatomical challenges as well as the likelihood of vascular and airway lesions make it one of the most lethal injury types of all Abbreviated Injury Scale regions. Traditional PNI management which divides PNI into anatomical zones is being reconsidered in light of high numbers of negative surgical explorations, weak correlation between the area of wounds and organ injury and significantly longer hospitalizations. <strong>CASE REPORT</strong> A 52-year-old female was admitted after a self-inflicted, right para tracheal stab wound. A cervico-thoracic computed tomography (CT) scan excluded vascular and other organ lesions. A right pneumothorax was treated with a chest drain and a right exploratory cervicotomy was performed. A pharyngoscopy and an esophagoscopy showed no lesions. <strong>

CONCLUSIONS

</strong> Advanced Trauma Life Support (ATLS) principles determine the initial assessment of PNI. Invasive airway management was required if orotracheal intubation is unfeasible. Hemodynamically unstable patients with platysma, vascular or aerodigestive lesions require surgery. Laryngotracheal injuries require panendoscopy and bronchoscopy prior to surgical exploration. Pharyngo-esophageal injuries may be treated conservatively. Esophageal lesions require timing dependent surgery. Recently, a "no zone" approach irrespective of anatomical classification shows improved results in stable PNI. Multidetector helical CT with angiography (MDCT-A) significantly reduces negative exploratory surgery. Consensus regarding the best management of PNI is shifting, as increasing evidence suggests a "no-zone" approach is more beneficial and cost effective.

Authors+Show Affiliations

Department of General Surgery, Hospital Center Valais Romand - Hospital Sion, Sion, Switzerland.Department of Thoracic Surgery, Hospital Center Valais Romand - Hospital Sion, Sion, Switzerland.Department of General Surgery, Hospital Center Valais Romand - Hospital Sion, Sion, Switzerland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31794545

Citation

Sgardello, Sebastian D., et al. "Anatomy of a Suicide: a Case Report." The American Journal of Case Reports, vol. 20, 2019, pp. 1801-1804.
Sgardello SD, Christodoulou M, Abbassi Z. Anatomy of a Suicide: A Case Report. Am J Case Rep. 2019;20:1801-1804.
Sgardello, S. D., Christodoulou, M., & Abbassi, Z. (2019). Anatomy of a Suicide: A Case Report. The American Journal of Case Reports, 20, pp. 1801-1804. doi:10.12659/AJCR.917993.
Sgardello SD, Christodoulou M, Abbassi Z. Anatomy of a Suicide: a Case Report. Am J Case Rep. 2019 Dec 3;20:1801-1804. PubMed PMID: 31794545.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anatomy of a Suicide: A Case Report. AU - Sgardello,Sebastian D, AU - Christodoulou,Michel, AU - Abbassi,Ziad, Y1 - 2019/12/03/ PY - 2019/12/4/entrez PY - 2019/12/4/pubmed PY - 2019/12/4/medline SP - 1801 EP - 1804 JF - The American journal of case reports JO - Am J Case Rep VL - 20 N2 - <strong>BACKGROUND</strong> Penetrating neck injuries (PNI) have a relatively low incidence constituting just 1.6% to 3.0% of overall suicide attempts. Nonetheless, the anatomical challenges as well as the likelihood of vascular and airway lesions make it one of the most lethal injury types of all Abbreviated Injury Scale regions. Traditional PNI management which divides PNI into anatomical zones is being reconsidered in light of high numbers of negative surgical explorations, weak correlation between the area of wounds and organ injury and significantly longer hospitalizations. <strong>CASE REPORT</strong> A 52-year-old female was admitted after a self-inflicted, right para tracheal stab wound. A cervico-thoracic computed tomography (CT) scan excluded vascular and other organ lesions. A right pneumothorax was treated with a chest drain and a right exploratory cervicotomy was performed. A pharyngoscopy and an esophagoscopy showed no lesions. <strong>CONCLUSIONS</strong> Advanced Trauma Life Support (ATLS) principles determine the initial assessment of PNI. Invasive airway management was required if orotracheal intubation is unfeasible. Hemodynamically unstable patients with platysma, vascular or aerodigestive lesions require surgery. Laryngotracheal injuries require panendoscopy and bronchoscopy prior to surgical exploration. Pharyngo-esophageal injuries may be treated conservatively. Esophageal lesions require timing dependent surgery. Recently, a "no zone" approach irrespective of anatomical classification shows improved results in stable PNI. Multidetector helical CT with angiography (MDCT-A) significantly reduces negative exploratory surgery. Consensus regarding the best management of PNI is shifting, as increasing evidence suggests a "no-zone" approach is more beneficial and cost effective. SN - 1941-5923 UR - https://www.unboundmedicine.com/medline/citation/31794545/Anatomy_of_a_Suicide:_A_Case_Report L2 - https://www.amjcaserep.com/download/index/idArt/917993 DB - PRIME DP - Unbound Medicine ER -