Here's what to do—and not do—when someone suffers a penetrating injury to the neck. 

By Maggie O'Neill
May 16, 2019

A recess break at school nearly turned fatal for an 11-year-old girl, whose injury and recovery is featured in a new case report from the BMJ.

The girl was playing outdoors when she fell, and a sharpened pencil accidentally became lodged into her neck. She was taken to a hospital for evaluation, but the pencil wasn’t removed at the scene of the accident. Good thing, too—if it had been, the girl could have bled out and died.

“On initial examination, there was a pencil protruding from the left side of the neck with no external bleeding or hematoma from the puncture site. Her initial vital signs were within normal range and there was no evidence of respiratory distress or stridor,” the case report says.

Since the child was stable, doctors decided to study what was happening in her neck before operating. They looked at the results of a computed tomography angiography (CTA), a diagnostic tool that allows doctors to analyze blood vessels using CT technology.

“This demonstrated that the pencil was lodged in her left common carotid artery (CCA) causing total occlusion,” the report says. (An occlusion is a closing or blockage of a blood vessel or a hollow organ.)

The girl was then taken to the operating room, where doctors clamped her arteries and removed the pencil. Remarkably, the girl recovered fully from her injury. “Ultrasound three years later demonstrated no abnormalities,” the report says.

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Penetrating neck injuries like the one this girl experienced can be more dangerous for children “due to their smaller anatomy,” the report says. “For this reason, it is important to completely evaluate and manage a child with penetrating neck trauma.”

The little girl’s story highlights the importance of making sure that if an object does penetrate the body during an accident, it isn’t immediately removed. The new report stresses that a penetrating object needs to stay put unless the affected person is “under direct surgical visualization.”

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