Unusual pediatric thoracic trauma management in a low-resource setting: A case report

Thoracic trauma is a significant cause of pediatric morbidity and mortality, although penetrating chest injuries from natural objects are rare. Due to the compliant nature of the pediatric chest wall, internal injuries can be severe even with limited external signs. Wooden foreign bodies present unique challenges because of their porous nature, high contamination risk, and potential to fragment. We report the case of an 11-year-old boy who sustained a penetrating thoracic injury when a coconut tree branch fell onto him in a rural setting. On presentation, he was hemodynamically stable but had respiratory distress and extensive subcutaneous emphysema, with a visible supraclavicular wound. Imaging revealed a right-sided pneumothorax and a retained wooden foreign body. Emergency intercostal chest drainage was performed, followed by a right anterior thoracotomy for safe extraction of the wooden fragment and repair of an associated right upper lobe lung laceration. Postoperatively, the patient developed a low-grade fever that was successfully managed with broad-spectrum antibiotics. He recovered without further complications and was discharged on the sixth postoperative day. This case underscores the importance of early recognition, prompt surgical management, and aggressive infection control in managing penetrating thoracic injuries caused by organic foreign bodies, particularly in low-resource rural settings.