DOI: 10.36347/sjmcr.2017.v05i07.012

Pages: 448-449

A 23-year-old female patient had experienced auditory hallucinations for a few years. One evening, she stabbed herself in the neck a few times while at home before going outside and diving from a bridge at midnight. A passerby found her under the bridge and called an ambulance. On inspection, she had three stab wounds at her neck, subcutaneous hemorrhaging at the right forearm and left elbow, and swelling of the right foot. She showed subcutaneous emphysema of the face, neck, and chest on palpitation. Emergency enhanced whole-body computed tomography (CT) revealed subcutaneous emphysema at her face and neck and pneumomediastinum, in addition to thoracolumbar disrupted fractures and pelvic fracture. However, there was no pneumothorax. Her neck wounds were directly closed by sutures. Emergency fixation of the calcaneus under spinal anesthesia was performed. Follow-up chest roentgen and truncal CT in the afternoon revealed right pneumothorax despite the subcutaneous emphysema at the neck decreasing in volume. She underwent indwelling chest drain for the pneumothorax. The thoracolumbar and pelvic fractures were managed observationally. After the diminishment of pneumothorax, the chest drain was removed. The course of her neck wounds was uneventful. She was transferred to an orthopedic ward on the ninth hospital day. Following the disruption of the membrane between the pneumomediastinum and pleural cavity, air in the pneumomediastinum may move into the pleural cavity, resulting in delayed pneumothorax. Physicians should be alert for the delayed onset of pneumothorax, which may advance to lethal tension pneumothorax, when treating patients with neck stab wounds.