A 61-year-old woman was stepping from one boat to another when she slipped and fell onto a flagpole. The pole entered the back part of the left side of her chest, crossed the crowded space at the center of her chest, and ended in her right lung. When she reached a trauma center two hours later, she was awake, fully oriented, and stable.
Thoracic surgeons at University Hospital Zurich describe the case in the September 2026 issue of the International Journal of Surgery Case Reports, in a report titled "A Swiss flag through the chest." To their knowledge, a flagpole impalement that crossed both lungs and the center of the chest without major lasting harm had not been described before in the indexed medical literature.
That central compartment, the mediastinum, holds the heart, major blood vessels, windpipe, and esophagus. Wounds that cross it, called transmediastinal injuries, are difficult to manage, and the authors cite reported death rates as high as 60%. Most are caused by gunshots, they note, but impalements can produce the same kind of injury.
Firefighters Cut the Pole So She Could Be Moved
According to the full case report, the local fire brigade used a cold saw to cut the flagpole so the woman could be freed and transported with the rest of it still in her body. She was airlifted to the Zurich trauma center, about 43 miles away by air, and arrived 120 minutes after the accident. During the rescue, she received continuous oxygen and 1 gram of intravenous tranexamic acid, a drug used to limit bleeding.
In the trauma room, doctors heard a wheeze over the top of her left lung but found no other injuries. A chest X-ray showed a foreign body about 30 centimeters long running from the left side of her chest toward the right. Because the pole entered far toward her back and angled up toward her neck, the team suspected damage to both the lungs and the mediastinum. Her hemoglobin was slightly low but did not require a transfusion.
Because she stayed stable, the team could get a CT scan first. The remaining pole was too long for the scanner, so it was carefully shortened again while staff kept it steady. The authors call cautious shortening of impaled objects that exceed CT scanner limits one of the case's key lessons.
A Path Between the Windpipe and the Esophagus
The CT scan mapped a remarkable route. The pole entered through the third intercostal space on the left, the gap between the third and fourth ribs, and passed through the upper lobe of the left lung. It then crossed the mediastinum near the aortic arch, the curved main artery leaving the heart, and slipped between the trachea and the esophagus before ending in the right lung.
To look for hidden tears, doctors examined her airway with bronchoscopy and her esophagus with esophagoscopy. The pole was pressing on the outside of the esophagus, but neither exam found an injury inside either structure.
Surgeons then performed a clamshell thoracotomy, a large incision across the front of the chest that opens both sides. They made it through the fourth intercostal space and extended it to the pole's entry point. They chose this approach over splitting the breastbone because the pole crossed the chest from side to side, and they needed to see every structure it might have damaged. The team also placed access lines in the groin so she could be put on a heart-lung bypass machine quickly if needed.
The operation confirmed that the pole had pierced both upper lung lobes and passed near the aortic arch. Surgeons removed it in a controlled way, and an exploration of the trachea found no injury.
Recovery Came with One Unexpected Setback
She was taken off the breathing tube 7 hours after surgery and spent three days in intensive care. After the operation, she developed tingling, nerve pain, and significant weakness when bending her right hand and moving her fingers. Doctors attributed the symptoms to irritation of the lower part of the brachial plexus, the nerve network that serves the arm, likely related to the pole's path into the right side of her chest. An MRI showed swelling or bleeding around the nerves but no break in them.
Those symptoms had improved substantially by the time she went home after an 18-day hospital stay, and the authors report no complications at follow-up.
The authors credit her stability for what followed. It allowed a full workup, including imaging, endoscopy and preparation for possible bypass, before the pole was removed. Transmediastinal injuries often require surgery because critical organs are so frequently involved, they wrote, although a small subset of stable patients needs only observation. The key challenge, in their view, is moving unstable patients quickly to emergency surgery while operating on stable patients only when their injuries could be fatal.
Why Rescuers Leave Impaled Objects in Place
Other reports show why that approach matters. A German case report on an impalement involving the aorta notes that penetrating wounds make up only 3% to 10% of chest trauma in industrialized countries and that few affected patients reach a trauma center alive. A report of an iron-rod impalement from Yemen, published in 2023, states that removing impaled objects outside the operating room is strongly discouraged because the object can help hold back bleeding. An object that is too long to transport, however, can be cut shorter.
Boats add hazards of their own. A 2022 review of watercraft-related injuries in Annals of Surgery Open found that boating accidents can cause virtually any pattern of injury, with case reports documenting harm to every region of the body.
This is a single case, and its lessons are aimed mainly at rescue crews and trauma teams. It cannot show how often flagpole impalements happen or how most patients fare. Anyone with an impaled object should call emergency services and leave the object in place for medical professionals to manage.
Key Questions Answered
What happened to the woman in the flagpole accident?
She slipped while moving from one boat to another and fell onto a flagpole. It entered the left side of her chest, crossed the center of her chest, and ended in her right lung.
Why are transmediastinal chest injuries so serious?
They cross the part of the chest that holds the heart, major blood vessels, windpipe, and esophagus. The case report's authors cite reported death rates as high as 60%.
Why was the flagpole cut instead of pulled out at the scene?
Firefighters cut it so she could be freed and transported, and it was shortened again so it would fit in a CT scanner. Medical case reports strongly discourage removing impaled objects outside the operating room.
What is a clamshell thoracotomy?
It is a large incision across the front of the chest that opens both sides. Surgeons chose it because it gave them a view of every structure the pole might have damaged.
Did she have any complications?
She developed nerve symptoms in her right hand after surgery, likely from irritation of the nerves serving the arm. They improved substantially before she went home after 18 days, and follow-up showed no complications.
What remains uncertain?
This is one case. It cannot show how common flagpole impalements are or how other patients with similar wounds generally do.
