Lodged pencil in the neck!

Case Report

An 11-year-old girl was transferred to The Hospital for Sick Children in Toronto, Ontario, from a regional health centre with a penetrating neck injury. During recess at her school, she fell and lodged the sharpened end of a pencil into the left side of her neck. She was urgently transported by ambulance with the pencil kept in place.

(Picture credit: © BMJ)

During recess at her school, she fell and lodged the sharpened end of a pencil into the left side of her neck. She was urgently transported by ambulance with the pencil kept in place.

The pencil was lodged in her left common carotid artery (CCA) causing total occlusion.

A first-generation cephalosporin was administered perioperatively. Using vessel loops, they gained control of the common carotid, internal carotid and external carotid artery (ECA) and then exposed the pencil.

Treatment

The patient was taken to the operating room for left neck exploration. A first-generation cephalosporin was administered perioperatively. Using vessel loops, we gained control of the common carotid, internal carotid and external carotid artery (ECA) and then exposed the pencil. She received a weight-based therapeutic dose of heparin, the arteries were clamped and the pencil was removed.

Neck exploration showing control of the left common carotid artery, internal carotid artery and external carotid artery with the pencil clearly dissected. (Picture credit: © BMJ)

Outcome

After an uneventful recovery in the hospital, the patient was discharged home on the second postoperative day. She was initiated on acetylsalicylic acid for 3 months following surgery. 

he wound was irrigated with copious amounts of sterile saline then closed in layers with vicryl and nylon sutures.

Credits: © BMJ

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