Aim The aim of this study is to describe the management of a patient who presents with a penetrating chest trauma due to impalement by an offending object, be it a knife, metal structure, or other type of object. Background Until today, many institutions have treated this type of injury with urgent thoracotomy, despite advances in thoracoscopy and radiologic studies. A review was performed principally to discuss the use of nonoperative treatment, thoracoscopy, and thoracotomy. Thirty-two patients described as case reports in 27 articles were reviewed to carry out this descriptive study. For each patient, the following variables were studied: Age, gender, trauma mechanism, hemodynamic stability upon admission, treatment type, injuries encountered and associated with the condition, complications, and the final disposition of death vs survival. Review results Twenty-one patients were treated with thoracotomy or sternotomy, seven patients with removal of the impaling object without surgery, and five patients with removal of the object using thoracoscopic assistance (one patient was treated with the assistance of thoracoscopy on the right side and with direct removal on the left side). A summary of the evidence reviewed is provided in a flowchart. Conclusion With technological advancements, especially in thoracoscopy and computed tomography, many of these injuries are responsive to less invasive treatment. Thoracotomy, considered the standard of care in many trauma centers, can be reserved for specific cases. Clinical significance Pursuant to some of the criteria listed in this study, as occurs in our institution, the thoracotomy rate can be reduced, thereby reducing mortality and benefiting patients. How to cite this article Botelho-Filho F, Drumond DAF, Starling SV, Peixoto LC, Zille DP, Constantino GDC. Object impaled in the Thorax: Review Study. Panam J Trauma Crit Care Emerg Surg 2016;5(3):148-154.

Introduction:This study wants to demonstrate that it is safe to treat pancreatic trauma conservatively in a developing country where resources are challenging. Materials and Methods:The study analyzed data from a Brazilian trauma center.Results: Thirteen patients from 2006 to 2017 had pancreatic trauma from low (I and II) and high grade (III) lesions and were treated conservatively. There was no mortality. Four patients had complications, but only one required laparotomy. In the study, a relationship was found with the degree of injury and time of hospitalization (p < 0.011), in addition to the presence of complications with the degree of complication (p < 0.021). Conclusion:Conservative treatment of pancreatic trauma has been performed in low and high grade lesions. It is believed that as long as there is a 24-hour surgical team, such as computed tomography (CT), the treatment of pancreatic trauma can be well-conducted. Clinical Significance:The study can decrease the number of unnecessary laparotomies.Objetivo: Este estudo quer demonstrar que é seguro tratar o trauma pancreático de forma conservadora em um país em desenvolvimento onde os recursos são desafiadores. Materiais e Métodos: O estudo analisou dados de um centro de trauma brasileiro.Resultados: Treze pacientes de 2006 a 2017 apresentaram trauma pancreático de baixo (I e II) e de alto grau (III), sendo tratados de forma conservadora. Não houve mortalidade. Quatro pacientes apresentaram complicações, mas apenas em um caso foi necessária laparotomia. No estudo, encontrou-se um relacionamento com o grau de lesão e tempo de internação (p 0,011), além da presença de complicações com o grau de complicação (p 0,021).Conclusão: o tratamento conservador do trauma pancreático é factível em lesões de baixo e alto grau. Acredita-se que, se houver uma equipe cirúrgica de 24 horas, com TC, o tratamento do trauma pancreático pode ser bem conduzido. Significância clínica: o estudo pode a diminuir o número de laparotomias desnecessárias.