A 26 year old male was impaled through his chest and upper abdomen with an iron angle, one and half meter long and five centimeters thick. The iron angle entered the chest, through the epigastrium and exited posteriorly just inferior to the angle of left scapula. The patient was transported to hospital with the iron angle in situ. Positioning the patient for intubation proved a major challenge. An unconventional position for intubation allowed a successful airway management. Paucity of time prevented us from gauging the nature and extent of injury. The challenges posed by massive impalement were successfully managed due to rapid pre-hospital transfer and co-ordinated team effort.A left thoracoabdominal incision was given joining the entry and exit wounds. The damage incurred was a lacerated left lobe of the liver, transected upper half of the spleen, almost 10 cm rupture of the stomach and divided central tendon of the diaphragm. Posteriorly the diaphragm and the left lung were lacerated before the bar exited the posterior thoracic wall fracturing the 7th, 8th and 9th ribs. The iron angle was lifted under vision directly from the surgical incision. Surgical procedures performed were splenectomy, gastroraphy, left phrenorraphy and the lung laceration was repaired. The surgery lasted for three hours. Total blood loss was approximately 1000 ml. Intraoperative arterial blood gas analysis was within normal limits.
