Knife wounds

Life is always an adventure particularly in this part of Kenya; one never quite knows what is just round corner. Unfortunately life is violent here as people do not trust the police and justice is therefore administered by vigilante action. This results in many knife wounds being inflicted. Some people present with multiple cuts and often several people are involved that sadly result in much morbidity and some deaths. In the last 24 hours we have had six patients with knife wounds only one of which was an accident in a lady who hit herself while cutting wood.

X-ray of the man with the "sucking " chest wound showing collapsed right lung

One night I was woken to see a man with a “sucking” chest wound. This is where there is a significant hole in the chest wall so when the patient breaths air is sucked in through the wound and out again when the patient breaths out. This makes breathing very difficult and on X-ray the lung was collapsed to the size of a tennis ball resulting in his life being in great danger. The wound was explored and I found with the force of the blow the track went straight through a rib. The situation was relieved by closing the wound and inserting a chest tube with immediate improvement. The lung completely expanded so much so that the tube was removed in 36 hours and the patient discharged the day after.  My only worry was

The knife wound in the chesst which had penetrated through a rib

that in the next bed was an almost identical patient with a similar stab wound admitted at the same time and I was worried hostilities may be resumed however they reassured me they were friends and had not been involved in the same fight.

The next notable case was a young man that had been assaulted by

Post-operation picture of the man who nearly lost his head!

an assailant using a panga [a large knife similar to a sword used in agriculture that is frequently carried in Kenya]. His attacker had made a serious attempt to cut this man’s head off. The knife had cut through all the muscles overlying the vertebrae at the back of his neck. Fortunately the knife had been deflected by the bone of the vertebral column thus protecting the cervical spine from injury. He was stitched up and discharged three days later. He had a happy smile on his face after the surgery and I was not sure if it was that he was so grateful to be alive or because he was planning retribution on the “person known to him” who had carried out the attack.

Stab wound in the left chest with clot having temporarily stopped the bleeding

The third case I want to present was a man with a stab wound in the left chest just overlying the heart. The patient had lost a significant amount of blood and there was a possibility of the knife having entered the heart. This patient needed operation quickly but there was an additional problem as the patient had advanced TB and the left lung appeared solid on X-ray and probably had little function. Fortunately the operation was much simpler than I had thought with a major vessel spurting just below a rib that I stopped relatively easily. The

Patient's X-ray showing severe TB with consolidation particularly of the left lung.

knife had gone deeply into the lung but because of the TB there was no air leak and no significant bleeding from the lung. Post operatively the patient is well and will be discharged home to continue his anti-tuberculous treatment as an out patient.

Bleeding controlled at the end of the operation

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