Left vertebral artery injury and cervical fracture from a cervical puncture wound caused by a pencil: pediatric case report

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  • Yamamoto Yutaro
    Department of Acute Care Surgery, Shimane University Faculty of Medicine Shimane Advanced Trauma Center, Shimane University Faculty of Medicine
  • Muronoi Tomohiro
    Department of Acute Care Surgery, Shimane University Faculty of Medicine Shimane Advanced Trauma Center, Shimane University Faculty of Medicine
  • Matsumoto Ryo
    Department of Acute Care Surgery, Shimane University Faculty of Medicine Shimane Advanced Trauma Center, Shimane University Faculty of Medicine
  • Kawaguchi Rui
    Department of Acute Care Surgery, Shimane University Faculty of Medicine Shimane Advanced Trauma Center, Shimane University Faculty of Medicine
  • Kuramoto Shunsuke
    Department of Acute Care Surgery, Shimane University Faculty of Medicine Shimane Advanced Trauma Center, Shimane University Faculty of Medicine
  • Oka Kazuyuki
    Department of Acute Care Surgery, Shimane University Faculty of Medicine Shimane Advanced Trauma Center, Shimane University Faculty of Medicine
  • Shimojo Yoshihide
    Department of Acute Care Surgery, Shimane University Faculty of Medicine Shimane Advanced Trauma Center, Shimane University Faculty of Medicine
  • Kidani Akihiko
    Department of Acute Care Surgery, Shimane University Faculty of Medicine Shimane Advanced Trauma Center, Shimane University Faculty of Medicine
  • Hira Eiji
    Department of Acute Care Surgery, Shimane University Faculty of Medicine Shimane Advanced Trauma Center, Shimane University Faculty of Medicine
  • Watanabe Hiroaki
    Department of Acute Care Surgery, Shimane University Faculty of Medicine Shimane Advanced Trauma Center, Shimane University Faculty of Medicine

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Other Title
  • 鉛筆による頸部杙創にて左椎骨動脈損傷・第7頸椎椎体骨折をきたした小児の1例

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Abstract

A 10-year-old girl fell indoors and her pencil stuck in her neck. She was admitted to our hospital, and contrast-enhanced computed tomography revealed left vertebral artery injury and fracture of the 7th cervical vertebra. We immediately performed balloon-assisted coil embolization on the proximal left vertebral artery, removed the pencil from her neck, and manually applied direct pressure to achieve hemostasis. The pencil lead had broken and remained inside the vertebra, so we administered antibiotics for one month after the operation to prevent infection. In this case, foreign body removal was performed after prior catheter embolization of the vertebral artery for a good prognosis. In Japan, four cases of vertebral artery injury from a stick wound have been reported in the past. Vertebral artery injury due to cervical puncture requires a therapeutic strategy （such as balloon-assisted embolization） to prevent hemorrhage and cerebral infarction from embolism during removal of foreign objects.

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