Miraculous Survival After Impalment By A Metalic Pole (Iron Angle)

A 22 year old male named Supratim Dutta met with a road traffic accident on the morning of 12th July 2008 (Saturday) at around 6.15 AM. Patient was travelling in a MNC cab, at Ghitroni on the Mehrauli- Gurgaon road, New Delhi. Allegedly the driver slept and the car hit a construction site of Metro (DMRC) at high speed. An iron angle from the construction site penetrated the bonnet of the car and impaled through the victim’s abdomen and chest. He remained fixed to the car for around half an hour. The patient was freed from the position after his friends reached the site and cut through the iron bar using gas cutters, with the help of Metro workers.

Supratim was rushed to the Jai Prakash Narayan Apex Trauma Center (JPNATC) of All India Institute of Medical Sciences (AIIMS) by 7.45AM, where the patient was carefully assessed and taken to the operation theatre at approximately 8.10AM.

Because of the awkward position of the iron angle, giving general anesthesia before surgery was a challenging task. The anesthesia team headed by Dr Chhavi Sawhney (Assistant Professor) did an excellent job giving the general anesthesia while the patient was seated.(usually general anesthesia is given in a lying down position). The surgical team was headed by Dr Biplab Mishra (Assistant Professor of Surgery) and Dr Sushma Sagar (Assistant Professor of Surgery). The surgery was very unconventional as four ribs had to be cut through so as to retrieve the iron bar directly from the surgical wound without causing any tissue damage. The usual tendency of general public psyche is to remove a penetrated foreign body by directly pulling through the wound, but in this case it would have damaged the nearby organs by the shearing force/ friction of the metallic pole. Especially in this case the metallic body was almost in contact with the heart and the left kidney.

The surgical incision was given at 9AM exactly and the iron bar was retrieved within 15 minutes. The bar had gone through the centre of upper abdominal wall and exited through the back of left side of chest wall. The following organs were injured by the bar:
1. Anterior abdominal wall (the front side of the abdomen),
2. Liver (left lobe-3cm laceration),
3. Stomach (>10cm perforation with two other small perforations),
4. Diaphragm was ruptured at two places- i. where the heart rests (central tendon of left diaphragm, the heart was missed by millimeters),ii above and behind the spleen,
5. Spleen ( upper half of spleen shattered),
6. Left lung (left lobe, 4cm laceration)
7. 10th rib fracture behind the torso along with chest wall.

The left kidney was missed by millimeters.
Patient was also very lucky not to sustain any injury to major blood vessel (descending aorta) in the adjacent area and spine.
Extensive repair of the stomach and diaphragm which were badly injured were done, spleen was removed and the ribs which were cut during the surgery were fixed by wiring. The whole surgery was performed in 3 hours and the blood loss was minimal (less than 400ml) during the procedure.
The patient was given special anesthesia (epidural) during the post operative period to reduce the level of pain. He was placed under intensive care in the ICU for two days.
He recovered very well in a short span of time.
He was stable through out the episode.
Presently he is accepting food orally, is ambulatory and doing well.

The team effort of JPNATC, AIIMS worked well in saving the life of the patient. This was celebrated by media in India for 2 or 3 days. You can read more on that by clicking here.