REMOVAL OF RETAINED INTRATHORACIC FOREIGN BODY AFTER PENETRATING CHEST TRAUMA : NEW INSIGHT

Presence of foreign body in thoracic cavity is very uncommon. Most common causes for the presence of such foreign bodies are traumatic, accidental or iatrogenic. The management involves urgent identication and removal of the foreign body. Surgical extraction using thoracotomy or video-assisted thoracoscopic surgery(VATS) remains the primary management strategy. Herein, we report the case of successful removal of retained foreign body from lung after 4 years of penetrating chest trauma by thoracotomy under intraoperative ultrasonographic guidance.

Single institutional experience of management of penetrating trauma chest

Chest trauma is now the second most common non-intentional traumatic injury. Chest trauma is associated with high mortality. Control of blood loss and stabilization of vital organs is of vital importance over diagnostic and therapeutic measures. Bleeding may arise from chest wall, intercostal or internal mammary arteries, great vessels, mediastinum, myocardium, lung parenchyma, diaphragm or abdomen. Modified early warning signs (MEWS) score of >9 on presentation have shown higher rate of mortality. Diagnostic modalities such as extended-focused assessment with sonography in trauma (eFAST) have been effective. The type of surgical approach alters according to the site of injury. We here presented our experience with six such patients. All the six patients involved in this study had penetrating trauma chest with various sharp weapons including dagger, ice pick, flag post. Time of presentation of all these patients were delayed due to ours being a tertiary centre. The patients were explored on the basis of eFAST findings, intercostal drainage, hemodynamics. Out of the six patients two patients succumbed and the patients who died also had high MEWS score. All the patients were approached surgically with respect to the type of injury sustained. Penetrating chest trauma present a challenging clinical situation which warrants early evaluation and intervention. The cases of chest trauma then be it blunt or penetrating should always be treated within the advanced trauma life support (ATLS) guidelines followed by the definitive management. Regardless of any penetrating object, the foreign body should be left in situ and only to be removed under vision. If in case the penetrating object has already been removed the operative intervention is decided on the amount of drainage. With blunt chest trauma, approximately 15% of the deaths result directly from intrathoracic injury, but with penetrating chest trauma, nearly 100% of the deaths result from intrathoracic injury. Hence, the operative exploration of the chest in penetrating chest trauma and should be done on emergent basis as the mechanism of injury, vital organ damage and hemodynamic status all equate to higher rate of mortality.

HEMOTHORAX FOLLOWING PENETRATING THORACIC INJURY (GUNSHOT WOUND) IN GERIATRIC PATIENT: A CASE REPORT AND EMERGENCY MANAGEMENT

Introduction: Penetrating chest trauma is highly lethal. Studies have reported up to 60% mortality depending on the mechanism of injury. While penetrating chest trauma is less common than blunt trauma, it can be more deadly. High-velocity gunshot injury resulting in penetrating thoracic trauma in geriatric patients poses a significant challenge for the traumatic surgeon. Hemothorax is usually a consequence of penetrating chest trauma. It can be caused by intercostal arterial bleeding, especially the posterior part. Initial treatment, including chest tube drainage insertion, is needed to avoid lung compression and to assess future treatment needed. Purpose: To report the patient survival from massive hemothorax caused by penetrating Thoracic injury caused by an air rifle, treated by chest tube insertion and posterolateral thoracotomy to take out the bullet several days after. Case Report: 70-year male patient came to the Emergency Room (ER) Adihusada Hospital Surabaya with a penetrating chest injury caused by an air rifle on the right side of the chest. The patient had chest pain, shortness of breath, and hypoxia. By inserting a chest tube, emergency management was done by a general surgeon due to the massive right hemothorax. An immediate chest tube insertion was needed to overcome the patient’s breathing problem to assess the future treatment needed. Chest X-ray and CT-Scan was done immediately after the patient’s hemodynamic were stable. Three days after hospitalizing, the Cardiothoracic and vascular surgeon performed posterolateral thoracotomy to take the bullet out of the chest. Conclusion: Seven days postoperatively, the patient was discharged from the hospital without any complications and stable hemodynamic. The patient went to the outpatient department for follow-up one week after.

Penetrating and blunt injuries of the heart - an abdominal surgeon’s personal experience in Serbia

Introduction. In the world with constantly increasing incidence of violence and trauma on one side, and more and more specialized surgeons on the other side; question about the role of abdominal surgeons in cardiac trauma emerges. Objective of this article is to show personal experience of an abdominal surgeon in managing heart trauma. Outlines of cases. We showed two penetrating injuries and one blunt trauma of the heart successfully managed by an abdominal surgeon. Conclusion. Abdominal surgeons should feel comfortable with the decision to operate on greatly physiologically deranged patients with penetrating chest trauma, and not to delay the operation with conservative measures or with time consuming transport to remote specialized facilities, since that could lead to greater death percentage of these patients.

Myocardial Infarction Following Repair of a Ruptured Heart

The patient was a 40-year-old man with penetrating chest trauma two days before being referred to our hospital.during first repair LAD artery was sutured.because of ongoing CP, he was candidate for bypass surgery and revascularization .The surgeon had reported ligation of LADA by some sutures during previous cardiac repair.