Times of India
21 April 2010
New Delhi,India

When 23–year–old Adama Ouattara, an Ivory Coast national, was brought to the AIIMS Trauma Centre, he had two iron rods piercing his chest and pinning him to the car’s seat.

“My first reaction was that of shock. Adama was pinned to the car seat. We immediately put him on IV fluids and started treatment, while police and fire officials made efforts to extricate him,” said Dr Lallan Kumar, senior resident, AIIMS Trauma Centre, who was on duty when Adama was brought to the hospital on Monday at 4.25am.

Adama was wheeled into the operation theatre 45 minutes later where doctors began the mammoth task of extricating the rods from his body. With two five–and–a–halffeet long rods jutting out of his body, Adama couldn’t lie down because of which doctors had difficulty giving him anaesthesia. “He was bleeding profusely, had low blood pressure, and couldn’t lie down. We administered anaesthesia with him sitting. Plus, we didn’t even have his basic tests reports,” said Dr Babita Gupta, assistant professor, anaesthesia, who is managing Adama post–surgery.

Extricating the rods was a big challenge. One rod had pinned his hand to his chest and the other was only a few inches lower. “We had to cut, from the back, nearly six ribs to reach the rods. The rods had perforated the lungs and had just missed the spine. While the ribcage was cut open, another team of doctors operated on the arm. Once we dislodged the rods from the right lung, we lifted the main blood vessel in the arm and pulled out the rod,” said Dr Amit Gupta, assistant professor, surgery, who, along with Dr Maneesh Singhal, performed the complex surgery. A portion of the lower lobe of the right lung was removed during surgery and Adama was given 33 units of blood and blood products.

Doctors say the two rods were exerting pressure on the left lung and heart, as Adama was made to lie on his left side during surgery. “He was on a ventilator and one lung was badly damaged. We had to remove the rods quickly, else the other lung could have been damaged,” said Dr Singhal.

Twenty four hours after the surgery, Adama’s condition continues to be critical. “The next four to five days are going to be critical. The risk of infection is high, after all he had a foreign object inside him for nearly three hours. There is also the risk of adult respiratory distress syndrome, deep vein thrombosis and complications arising out of multiple blood transfusions. But we are hopeful that he will make it,” said Dr M C Misra, chief, AIIMS Trauma Centre.

Appreciating the presence of mind of police and fire officials, Dr Misra said, “I have never seen a patient brought to the hospital in this condition
‘It was a good idea to bring the patient in the car itself because we were able to treat him while police and fire officials got him out of the car.’ We now plan to stock equipment which can be used in similar situations.”

Patient was Pinned to His Seat
Doctors at AIIMS Trauma Centre extricate two rods from 23–year–old Adama’s body. His condition is still critical

Treatment Procedureand Challenges

Herculean effort: A total of 25 doctors and paramedical staff have been involved in looking after Adama, who has been administered a total of 50 units of blood and blood products
• IV fluid given to Adama while he was being pulled out of the car
• Giving him anaesthesia was difficult. Adama’s blood pressure was low and doctors didn‘t have other test reports

1. His right arm was pinned to his chest. Doctors cut, from the back, 6 ribs to get to 2 rods that had perforated his right lung
2. Part of the lower lobe of the right lung was removed
3. Once the rod piercing his arm and chest was dislodged, doctors lifted the arm’s main blood vessel and pulled out the rod

Rods weighed 15 kg each

• The rods were five–and–a–half feet long, 1.5 inches in diameter; Weighed 15kg each
• Time taken to remove rods: 45 min; Surgery completed in 4 hours
• Number of doctors and paramedical staff involved: 25
• Amount of blood and blood products used: 50 units (33 during surgery and 17 in post–operative care)

Post–Surgery Risk

• High chances of infection
• Can suffer from Adult Respiratory Distress Syndrome
• Complications due to multiple blood transfusions
• Could have deep vein thrombosis
  ‘During the surgery, the rods were putting pressure on the heart and the left lung: Dr Amit Gupta