Penetrating Abdomino‑Pelvic Trauma: Initial Assessment and Diagnostic Challenge  A Case Report

• Dr Kessentini Hana

  hopital habib bourguiba service des urgences

• Dr Fedi Ben ali

  Hopital Universitaire Habib Bourguiba

• Dr Rim karray

  Hopital Universitaire Habib Bourguiba

• Dr Emna Gharbi

  Hopital Universitaire Habib Bourguiba

• Dr Roua Mahjoub

  Hopital Universitaire Habib Bourguiba

• DR Mouna Jerbi

  Hopital Universitaire Habib Bourguiba

• Dr Olfa Chakroun

  Hopital Universitaire Habib Bourguiba

• Dr Nouredine Rekik

  Hopital Universitaire Habib Bourguiba

Background: Penetrating abdominopelvic trauma usually stems from stab wounds or gunshots. Workplace impalement by foreign objects is rare and presents distinct diagnostic and therapeutic challenge. We report an exceptional case of trans‑abdominal impalement by a metallic rod with an unusual trajectory yet minimal internal damage.

Case presentation: A 30‑year‑old male industrial worker was referred after a workplace accident in which a metal rod penetrated his lower back, traversing the posterior lumbar region, retroperitoneum and peritoneal cavity. On arrival he was hemodynamically stable, fully conscious (GCS 15/15), with a negative FAST .Contrast‑enhanced abdominopelvic CT demonstrated the metallic rod’s oblique vertical course through paravertebral muscles, psoas, retroperitoneum and peritoneal cavity anterior to the descending colon, with signs of jejunal perforation (mesenteric air and fat stranding) but no major vascular, visceral or skeletal injury. The rod was surgically removed; the perforated jejunal segment was resected and a jejuno‑jejunal anastomosis performed. Post‑operative recovery was uneventful and the patient was discharged on day 3 in stable condition.

Conclusions: This case highlights two key points: the first one is even when a foreign object follows a long, high‑risk trajectory, internal damage may be surprisingly limited depending on dynamics and anatomy. The second that a negative FAST examination in a hemodynamically stable patient does not exclude significant intra‑abdominal injury  timely cross‑sectional imaging or surgical exploration remains essential. Awareness of atypical impalement injury patterns is crucial for accurate diagnosis and optimal outcomes

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