Management of a Penetrating Thoracic Injury with Thoracoscopy; A Case Study
Abstract
Introduction: Various strategies could be considered dealing with penetrating thoracic injuries. Thoracoscopy is much less invasive than routine thoracotomy approach for managing such cases in which the sharp object remains in the body. The case presented in this article was managed with thoracoscopy for a penetrating dorsolateral thoracic injury. Case Presentation: A 35-year-old man with a penetrating dorsolateral thoracic injury referred to the emergency department. Despite an elevated pulse rate, the patient has proper blood pressure and O2 saturation. Considering the patient's stability and the results of imaging which did not show any massive vascular injury, the patient was taken to the operation room for thoracoscopy. At thoracoscopy, we saw 4 cm of the blade in the thoracic cavity between the third and fourth intercostal space. There was a mild laceration of lung tissue without any active bleeding. Considering the position of the blade and the absence of active bleeding and vascular injury at the trauma site, we successfully removed the blade by the thoracoscope without any complications. Conclusion: Our experience of removing a retained knife by thoracoscopy showed that it can be an appropriate alternative for patients with penetrating thoracic injury who are hemodynamically stable and have appropriate conditions for thoracoscopy.
2. Ali J, Gana TJ, Howard M. Trauma mannequin assessment of management skills of surgical residents after advanced trauma life support training. J Surg Res. 2000;93(1):197-200.
3. Demetriades D, Kimbrell B, Salim A, Velmahos G, Rhee P, Preston C, et al. Trauma deaths in a mature urban trauma system: is “trimodal” distribution a valid concept? J Am Coll Surg. 2005;201(3):343-8.
4. Thomson BN, Knight SR. Bilateral thoracoabdominal impalement: avoiding pitfalls in the management of impalement injuries. J Trauma. 2000;49(6):1135-7.
5. Sobnach S, Nicol A, Nathire H, Kahn D, Navsaria P. Management of the retained knife blade. World J Surg. 2010;34(7):1648-52.
6. Ziomek S, Read RC, Tobler HG, Harrell JE, Gocio JC, Fink LM, et al. Thromboembolism in patients undergoing thoracotomy. Ann Thorac Surg. 1993;56(2):223-7.
7. Rogers ML, Duffy JP. Surgical aspects of chronic post-thoracotomy pain. Eur J Cardiothorac Surg. 2000;18(6):711-6.
8. Rogers M, Henderson L, Mahajan R, Duffy J. Preliminary findings in the neurophysiological assessment of intercostal nerve injury during thoracotomy. Eur J Cardiothorac Surg. 2002;21(2):298-301.
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Issue | Vol 4 No 1 (2020): Winter (February) | |
Section | Case (report / study) | |
Keywords | ||
Case Management Implements in-situ Thoracic Injuries Thoracoscopy Wounds, Penetrating |
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