Haematosinus et causa Luka Tusuk Akibat Anak Panah Busur

(Laporan Kasus)
Haematosinus Resulting From a Stab Wound due to Arrow
(A Case Report)

Indah Wulan Sari1, Andi Iqbal Iskandar1, Yosephine Siahaan1, Deiby T.I. Saumana1, Ressy
Dwiyanti1, Indrayaty A.R.1, Natalia Widjaya1, Geebert J.M.T. Dundu1, Denny Mathius
Sendana1,2, Jerny Dase1,3, Gatot S. Lawrence1,4
1
Departemen Kedokteran Forensik & Medikolegal Fakultas Kedokteran Universitas Hasanuddin
Makassar, 2Instalasi Forensik RS Bhayangkara Makassar, 3Instalasi Forensik RSUP Dr. Wahidin
Sudirohusodo Makassar, 4Departemen Patologi Anatomi Fakultas Kedokteran Universitas
Hasanuddin Makassar

ABSTRACT

Introduction : Stab wounds caused by bow arrows is an extremely rare form of trauma in most
developed country, but constitutes 0.1% of emergencies in developing countries. The most
common form of wound in developed countries is gunshot wounds, but it is very different in
developing countries, where blade, spear, bow, arrow, and machete are in the list of their
weapons choice, especially in a traditional society. In the Developing Country like Indonesia,
there are many incidents of injuries resulting from the arrows and the bows. One of the major
city in Indonesia that still frequently use the bows in conflict and fights is Makassar. Trauma in
maxillofacial region because the arrow wound is rare. Radiological work up is an important
modality on this case. CT-scan or even MRI is very helpful, as it can assess the extent to which
the stab-arrow wound inside the skull.
Case : a 20 year old male patient was admitted to the emergency room of Dr. Wahidin
Sudirohusodo Makassar General Hospital with an stab wound of arrows in right maxillofacial
region.
Results : The patient was admitted fully consciouss, GCS on scale 15, vital signs within normal
limits, and a foreign body (an arrowhead) was seen and stuck in the right maxillofacial region.
The foreign body was made of iron, round in shape with a base is in the form of a tassel that has
a length of ten point five centimeters from the surface of the injured skin. There was no active
bleeding. There was bandage that covered the area around the wound and some foreign objects
so that it was difficult to assess the condition of the wound. Radiological examination results
(head CT scan) showed a stab wound (vulnus ictum) caused by a linear mental density (bow)
with the distal tip entering the infraorbital area and maxillary sinuses at a distance of about three
point seven centimeters from the skin (cutaneous), blood collection in the right skull cavity.
(haematosinus ethmoid dextra) and right cheek cavity (haematosinus maxillary dextra),
destruction of the os infraorbital dextra and the right maxillary sinus, bulb oculi and retrobulbar
space are within normal limits.
Discussion: Foreign bodies in the maxillary sinuses are usually caused by penetrating trauma.
Such as in this patient because of a stab wound in the maxillary sinus area, thus causing
accumulation of blood (haematosinus) in the maxillary sinus. Hematosinus in this patient is
difficult to be seen clearly on a plain radiological examinations, but is easily visible on a CT
scan. Management of trauma should be in accordance with the patient's life saving. Bow
extraction are carried out by surgeons.
Conclusion: Stab wounds resulting from an arrow in the maxillofacial region are extremely rare.
Radiological examination is important in the case of stab wound, as it can assess the extent of
stab wound in the patient. So that it can be immediately determined the right management, in
accordance with the injury or the result.

Key words: Arrow, hematosinus, stab wound.