A clinical case of surgical treatment of a knife-penetrated wound of the right atrium and the aortic root 2 years after the injury

<p>Chest injury is an acute, extremely life-threatening condition. Among penetrating heart wounds, approximately 85% are stab wounds. In the case of stab and cut injuries, the lethality, according to various sources, reaches 90% and directly depends on the time of delivery of the victim to the hospital. In the overwhelming majority of cases, emergency operations for stab wounds of the chest are conducted in general surgical hospitals. As a rule, when providing emergency surgical care, only superficial heart wounds are sutured, excluding the correction of damage to the intra-cardiac structures. Aorto-right atrial fistula is a rather rare clinical condition that is formed due to the action of a traumatic factor and is characterised by the formation of a communication between the aorta and the right atrium with the discharge of arterial blood into the venous system. Considering that this pathology is accompanied by an increase in pressure in the right atrium, signs of stagnation are found in the systemic circulation, followed by compensatory dilatation of the right atrium and then dilatation of the right ventricle. The only effective method to treat this problem is surgery.<br />The presented clinical case demonstrates the surgical treatment of chronic post-traumatic aorto-right atrial fistula, pseudo-aneurysm between the non-coronary sinus and the right atrium and pseudo-aneurysm of the left coronary sinus 2 years after the stab wound. Echocardiography performed after surgery indicated a positive trend, i.e., a decrease in the size of the right- and left-sided heart and normalisation of pressure in the pulmonary artery. No inter-chamber shunts were found. This case shows that clinicians must remember that after providing emergency surgical care to patients with penetrating chest wounds, it is necessary to conduct an additional examination of the heart after stabilisation of the condition to detect hidden damage to the intra-cardiac structures.</p><p>Received 2 February 2021. Revised 2 March 2021. Accepted 3 March 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

Penetrating injuries in Germany – epidemiology, management and outcome an analysis based on the TraumaRegister DGU®

Background The management of penetrating wounds is a rare challenge for trauma surgeons in Germany and Central Europe as a result of the low incidence of this type of trauma. In Germany, penetrating injuries are reported to occur in 4–5 % of the severely injured patients who are enrolled in the TraumaRegister DGU® (trauma registry of the German Trauma Society). They include gunshot injuries, knife stab injuries, which are far more common, and penetrating injuries of other origin, for example trauma caused by accidents. The objective of this study was to assess the epidemiology and outcome of penetrating injuries in Germany, with a particular focus on the level of care provided by the treating trauma centre to gain more understanding of this trauma mechanism and to anticipate the necessary steps in the initial treatment. Materials and methods Since 2009, the TraumaRegister DGU® has been used to assess not only whether a trauma was penetrating but also whether it was caused by gunshot or stabbing. Data were taken from the standard documentation forms that participating German hospitals completed between 2009 and 2018. Excluded were patients with a maximum abbreviated injury scale (MAIS) score of 1 with a view to obtaining a realistic idea of this injury entity, which is rare in Germany. Results From 2009 to 2018, there were 1123 patients with gunshot wounds, corresponding to a prevalence rate of 0.5 %, and 4333 patients with stab wounds (1.8 %), which were frequently caused by violent crime. The high proportion of intentionally self-inflicted gunshot wounds to the head resulted in a cumulative mortality rate of 41 % for gunshot injuries. Stab wounds were associated with a lower mortality rate (6.8 %). Every fourth to fifth patient with a gunshot or stab wound presented with haemorrhagic shock, which is a problem that is seen during both the prehospital and the inhospital phase of patient management. Of the patients with penetrating injuries, 18.3 % required transfusions. This percentage was more than two times higher than that of the basic group of patients of the TraumaRegister DGU®, which consists of patients with a MAIS ≥ 3 and patients with a MAIS of 2 who died or were treated on the intensive care unit. Conclusions In Germany, gunshot and stab wounds have a low incidence and are mostly caused by violent crime or attempted suicides. Depending on the site of injury, they have a high mortality and are often associated with major haemorrhage. As a result of the low incidence of these types of trauma, further data and analyses are required in order to provide the basis for evaluating the long-term quality of the management of patients with stab or gunshot wounds.

A survived case of penetrating neck injury with intrathoracic organ damage

Background Thoracic surgeons rarely encounter stab wounds with injury to the intrathoracic organs. However, such sudden and urgent situations could arise; therefore, experiences in managing such cases are invaluable. Case presentation An 84-year-old woman with depression who had a stab injury in the neck caused by a broad-bladed kitchen knife was brought to our facility by ambulance. She was stable in the emergency room; however, a computed tomography scan revealed that the blade had penetrated the right thoracic cavity. A right hemopneumothorax was seen. Considering the possibility of injury to the major vessels, a median sternotomy was performed. During the dissection around the blade, the patient started bleeding profusely, which required repair of an injury to the right internal jugular vein. The blade tip had penetrated the dorsal right upper lung lobe; however, it did not reach the hilum, and the knife was carefully removed. The damaged area of the lung was removed by wedge resection. Conclusion Patients with deep stab wounds from knives are often hemodynamically stable because the blade acts as tamponade and prevents hemorrhage. Therefore, a surgical approach that allows for good visualization should be considered for the extraction of the blade.