The blade within: Successful surgical management of a retained knife in abdomen

Stab wounds, in particular, present unique challenges due to the potential for injury to vital organs and vascular structures, especially when the trajectory involves both the thoracic and abdominal cavities. Management strategies range from selective non-operative management (SNOM) in select cases to surgical exploration when hemodynamic instability, peritonitis, or retained foreign objects are evident. This case report describes the case of a young male who sustained a stab injury to the right thoraco-abdomen, resulting in a hemothorax and penetration of the diaphragm and liver by a retained foreign object. A 25-year-old male arrived in the Trauma emergency department with an alleged history of stab injury with a knife to over right side chest. Chest x-ray revealed right hemothorax and a foreign object in the right upper quadrant of the abdomen. Intercostal tube drainage (ICTD) was put on the right side in the 5th intercostal space. On exploration, it revealed part of a knife poking into the right lobe of the liver and a rent of size 2x1cm over the right crus of the diaphragm. Hemostasis achieved and abdomen closed. He made an uneventful recovery. Penetrating trauma to the thoracoabdominal region, particularly with retained foreign objects such as knives, presents unique clinical and surgical challenges. In stable patients, imaging plays a pivotal role in assessing the trajectory of the foreign object and potential injuries.Controlled removal of the foreign object under direct visualization, combined with appropriate vascular control, proved effective in managing injuries to the liver and diaphragm in this case.