Citation

Bhatt NR, McMonagle M. BMJ Case Rep. 2015; 2015(ePub): ePub.

Affiliation

Department of Surgery, University Hospital Waterford, Waterford, Ireland.

Copyright

(Copyright © 2015, BMJ Publishing Group)

DOI

10.1136/bcr-2015-212666

PMID

26621867

Abstract

The newer approach to management of penetrating neck injuries (PNI) involves the No Zone approach: comprehensive physical examination combined with CT angiography for triage to effectively identify or exclude vascular and aerodigestive injury. This approach, however, has a low negative exploration rate; there is risk of missing occult injuries especially Zone I and III PNI. We report a case of a patient with PNI to Zone I of the neck who was haemodynamically stable at presentation; CT scan revealed complete occlusion of the common carotid artery. Immediate surgical exploration revealed an occult hypopharyngeal injury in addition to the arterial trauma, which was missed on the CT scan. Hence the No Zone approach needs cautious clinical application, especially in Zone I injuries.

Language: en