Medieval (arrow) weapon injuries in contemporary surgical practice: Impaled posterior thoracic wall arrowhead leading to haemo-thorax: Management protocols. Case report

INTRODUCTION AND IMPORTANCE: Arrow injuries are rare in modern surgical practice. However, there are still case reports in tribal and guerrilla conflicts in rural settings were arrows are still used as weapons. Since the discovery of gun powder, guns and explosives have been the preferred effective assault weapons. Most surgeons in metropolitan trauma centers face scarce arrow injuries cases, mostly due to accidents or suicide attempts using the crossbow mechanism. CASE PRESENTATION: We present a case of an 18-year-old boy who sustained penetrating posterior thoracic wall arrow injury leading to haemothorax and review of the management protocols. CLINICAL DISCUSSION: Arrow injuries to the chest can span the entire spectrum of organs in the chest cavity ranging from superficial muscle to vital organs and vessels injury. Immediate death can result from injury to vital organs or vessels with late fatalities due to infection or toxins from dipped arrow heads with “poisons”. Pre-operative radiological investigations such as CT scanning with angiography have proved its predictive value of intra-thoracic injuries when compared to post-operative diagnoses. CONCLUSION: Management protocols range from open thoracotomy of unstable patients to simple retrieval under thoracoscopy guide. Several management protocols set date back as early as the 16th Century still hold water to date.