Impalement lesions are defined as large objects or foreign bodies, usually wooden objects, penetrating a body cavity or extremity and remaining in place. The clinical diagnosis is obvious, and under no circumstances should the object be removed at the scene. There should be no delay in radiological investigations. A 42-year-old man was brought to the emergency department by the fire department for management of a thoracoabdominal impalement with a tree branch in place during a road traffic accident 2 hours prior to admission. The CT scan showed the trajectory of the branch intra-abdominally, and a 6th rib fracture. Investigation: perforation of left diaphragmatic dome, breach of mesentery, bowel perforation. Procedures: phrenorrhaphy, bowel repair and conservative ileostomy. The postoperative course was straightforward, and the patient was discharged on postoperative day 15. Thoracoabdominal impalement wounds may not reflect the severity of internal injuries. Emergency surgery to remove the object should not be delayed.