A 15 year old boy, in Mumbai is brought to the emergency depament with several stab wounds inflicted during an attack by members of a rival street gang. One lesion, between the 9th and 10th ribs along the left posterior axillary line, penetrated to a depth of about 5 cm. Which of the following organs would be the first one pierced by the sharp object that caused this injury?
The spleen follows the long axes of ribs 9 to 11 and lies mostly posterior to the stomach, above the colon, and paly anterior to the kidney. Therefore, it is the most likely organ of the group to be pierced by a sharp object penetrating just above rib 10 at the posterior axillary line. Note that the pleural cavity, and possibly the lower pa of the inferior lobe of the lung, would be pierced before the spleen.The ascending colon is on the wrong side (the right) to be penetrated by a sharp instrument piercing the left side. Most of the duodenum is positioned too far to the right to be affected by this injury. Even the third pa of the duodenum, which runs from right to left, would still be out of harm's way. In addition, the duodenum lies at about levels L1 to L3, placing it too low to be injured in this case. The superior pole of the left kidney is bordered by the lower pa of the spleen. However, it is crossed by rib 12 and usually does not extend above rib 11. It would probably be too low and medial to be injured in this case, since this penetration is at the posterior axillary line.
Ascending colon
Duodenum
Left kidney
Spleen