Chopstick Stab in the Right Ventricle

An 18-year-old woman had a playful fight with her younger brother during dinner. They slipped on the floor together and a chopstick incidentally pierced her chest. She was subsequently transported to our hospital by ambulance with the chopstick in situ. Her hemodynamics were stable without tachycardia or hypotension. The chopstick was caulk-fixed with her shirt and was moving according to her heartbeat. Computed tomography revealed that the tip of the chopstick was located in the right ventricle without cardiac tamponade (Figure A–D); therefore, an emergency operation was performed. First, the patient’s shirt around the chopstick was removed before prepping. A 6-cm skin incision was made on the lower sternum. A reversed L-shaped lower sternotomy from the left third intercostal space was made, and a retractor was placed; as a result, the entry of the chopstick loosened and simultaneously began to bleed. The chopstick was removed, and the bleeding was controlled with finger pressure underneath the sternum. A traction stitch was placed on the anterior wall of the right ventricle, which was retracted caudally to obtain a better surgical view. Subsequently, the right ventricular wall injury was repaired with a 4-0 polypropylene pledgeted mattress suture. The operation was completed successfully (Supplementary Movie). The patient was discharged 4 days after the operation without any complications. In this case, the patient’s shirt acted as a caulking agent that placed the chopstick into a fixed position, contributing to the extremely stable preoperative hemodynamics without cardiac tamponade, avoiding catastrophic consequences.

Figure.

Computed tomography images of the patient with a penetrating cardiac stab wound. (A) Entry of the chopstick into the chest surface. (B) Chopstick penetrating through the left third intercostal space. (C) Oblique sagittal image showing the chopstick stab into the right ventricle. (D) Axial image showing absence of pericardial effusion. Arrow indicates the chopstick.

Sources of Funding

This study received no funding.

Disclosures

The authors have no conflicts of interest to disclose.

Supplementary Files

Supplementary Movie. Intraoperative movie.

Please find supplementary file(s);

https://doi.org/10.1253/circrep.CR-24-0043