A CASE REPORT ON SELF-INFLICTED MULTIPLE PENETRATING INJURIES TO THE NECK, CHEST, AND ABDOMEN IN A YOUNG FILIPINO ADULT gslaquindanum@gmail.com

 

A CASE REPORT ON SELF-INFLICTED MULTIPLE PENETRATING INJURIES TO THE NECK, CHEST, AND ABDOMEN IN A YOUNG FILIPINO ADULT

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Philippines

Oral or Poster

Suicide is a major global public health issue, ranking fourth among causes of death in ages 15-29 (WHO, 2019). In the Philippines, the suicide rate is 2.5 per 100,000, with hanging most common, and male deaths aged 20-24 occurring four times greater (DOH, 2019). This report is an unusual case of a 21-year-old Filipino who cut his throat and stabbed himself multiple times to the chest and abdomen, highlighting acute and postoperative care challenges.

Primary survey was conducted, and airway was primarily secured via transcervical tracheal intubation, through the gaping wound, and past the directly-visualized laryngeal inlet. After volume resuscitation, emergent neck exploration, tracheostomy, primary repair of the esophagus and pharynx, and laparotomy followed.

Intraoperatively, there was transection at the level of the pharynx, partial transection of right sternocleidomastoid muscle and external jugular vein. To facilitate reconstruction, tracheostomy was performed followed by nasogastric tube insertion under direct visualization through the wound, and retubularization of the pharynx was done. Because of a positive FAST result and episode of hypotension, laparotomy was conducted yielding 1.5 liters hemoperitoneum from a 2-cm non-bleeding segment 2 liver laceration. Post-operative management at the intensive care unit focused on early liberation from mechanical ventilation and enteral feeding.

Penetrating neck injuries are life-threatening and may cause lasting complications based on affected structures. Immediate airway management is of paramount importance. Postoperative care prioritizes adequate nutrition through enteral feeding, early ventilator weaning, sepsis prevention, and ongoing collaboration with mental health services to provide medical therapy and prevent future suicide attempts.