Not-so-Minor Injuries: Delayed Diagnosis of a Large Splinter

Authors

1 General Surgery Department, Northwick Park Hospital, London, UK

2 Baylor Scott and White Memorial Hospital, Temple, Texas

Abstract

Introduction
In contrast with victims of major trauma, patients who suffer minor injuries receive little specialist input. In most cases, this causes no difficulty, but there are situations where minor trauma results in persistent disability affecting the quality of life.


Case Presentation
A young man sustained a perineal puncture wound resulting from a fall onto a bush. Following an initial delay, he sought medical advice for a continual pain in his right leg, and a discharging perineal wound. A computed tomography (CT) scan and flexible sigmoidoscopy failed to identify the cause, and he was subsequently discharged from hospital. One year after his initial presentation, a magnetic resonance imaging (MRI) scan identified a retained foreign body consistent with a fragment of wood.


Conclusions
Penetrating trauma from wooden fragments provides a diagnostic challenge. A stubborn discharge from a wound must always raise the suspicion of retained fragment. Early and appropriate surgical exploration is imperative.

Keywords


1. Gul S, Dusak A, Songur M, Kalayci M, Acikgoz B. Penetrating

spinal injury with a wooden fragment: a case report and review

of the literature. Spine (Phila Pa 1976). 2010;35(25):E1534–6. doi:

10.1097/BRS.0b013e3181d9b7f8. [PubMed: 21102287].

2. Paul AM, Grundmann T. [Intraorbital wooden foreign body undetected

on CT]. HNO. 2010;58(12):1237–40. doi: 10.1007/s00106-010-2192-9.

[PubMed: 21085921].

3. Ginsburg MJ, Ellis GL, Flom LL. Detection of soft-tissue foreign bodies

by plain radiography, xerography, computed tomography, and ultrasonography.

Ann Emerg Med. 1990;19(6):701–3. [PubMed: 2188542].

4. Rao J, Messahel A, Grimes K, Sanders K. Elusive penetrating foreign

body to the neck causing partial epiglottic airway obstruction. J

Craniomaxillofac Surg. 2011;39(1):37–9. doi: 10.1016/j.jcms.2010.03.004.

[PubMed: 20456968].

5. Rockett MS, Gentile SC, Gudas CJ, Brage ME, Zygmunt KH. The use of

ultrasonography for the detection of retained wooden foreign bodies

in the foot. J Foot Ankle Surg. 1995;34(5):478–84. doi: 10.1016/S1067-

2516(09)80024-0. [PubMed: 8590883] discussion 510-1.