Abstract
Penetrating head trauma is the most fatal form of head injury. Although many cases of penetrating head trauma have been reported in the literature, its management remains complex, requiring a multidisciplinary team, which makes it a challenge in district hospitals where human resources and technical equipment are limited. We aim to present a successful initial management of a case of penetrating head trauma in a rural district hospital before a transfer to a first category hospital. A 27-year-old man, smoker with no pathology history was involved in a road accident, falling from a motorbike without a helmet. In admission to our rural district hospital, the Glasgow Coma Scale during physical examination was 6/15 with bilateral mydriasis, haemodynamic distress and good saturation. A penetrating head injury was identified with profuse intracranial haemorrhage. Intracranial packing known in damage control neurosurgery to tamponade severe intracranial haemorrhage and which is a lifesaving neurosurgical manoeuvre was used. The patient was transferred unconscious to a first-category hospital, free of intubation and in a stable haemodynamic state. The post-operative period was marked by convulsive seizures, for which the patient was put on anticonvulsants with a good outcome. At rural district hospital level, when faced with a penetrating head trauma, the principles of neurosurgical damage control must be well-known in order to optimise the use of available resources.