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2011 | 83 | 3 | 117-122
Article title

Penetrating Abdomino-Thoracic Injuries: Report of Four Impressive, Spectacular and Representative Cases as Well as Their Challenging Surgical Management

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Languages of publication
EN
Abstracts
EN
Gunshot wounds are rare events in European countries, but stab and impalement injuries occur more frequently and are often spectacular.The aim of the study was to describe several types of penetrating abdomino-thoracic injuries as well as the appropriate surgical interventions, including complex wound management.Material and methods. The representative case series includes four patients with abdomino-thoracic penetrating trauma (two impalements and two stabbings), who were treated in a surgical university hospital (tertiary) centre during a 12-month period.Results. 1. A man was impaled on a steel pipe, which entered the body above the right kidney and behind the liver through the mediastinum via the right thorax, passing the heart and aortic arch up to the left clavicle. The rod was removed via sternotomy and median laparotomy. Only the left subclavian vein required repair. Postoperatively, a residual lesion of the left brachial plexus caused temporary pneumonia. 2. A leg of a collapsing chair drilled into a woman's left foramen obturatorium and exited the body at the right anterior iliac spine. At a regional hospital, the chair leg was removed and the canal caused by gluteal penetration was excised. Exploratory laparotomy revealed peritonitis resulting from a perforated ileum. The injury was repaired with segmental resection and anastomosis. Postoperative right inguinal wound necrosis necessitated excision and vacuum-assisted closure sealing. The patient has residual paresthesia in her left leg resulting from a sacral plexus lesion. 3. During an altercation, a man was stabbed twice in the right thorax. The right pulmonary lobe, the diaphragm, and the liver dome between segment VIII and V were injured. The patient also had a large scalp avulsion at the left and right parietooccipital site and transection of the biceps muscle at the middle third of the right humerus. The chest injuries, approached via right subcostal incision and right anterior thoracotomy were managed with liver packing (two towels, removed after 2 days), suture of the diaphragm, and pleural drainage. 4. A man was stabbed in the left thorax, resulting in pneumothorax and lesions of the diaphragm and left third of the transversal colon, and the neck, resulting in lesions of the pharynx and internal jugular vein. These injuries were approached with left thoracic drainage and suture of the colon and diaphragm lesions. Subsequent right thoracotomy was required to treat right pleural empyema caused by bronchopneumonia as a consequence of blunt thoracic trauma. In addition, the patient required relaparotomy to drain an abscess within the Douglas space and Billroth II gastric resection to control recurrent Forrest-Ia bleeding.Conclusions. Penetrating abdomino-thoracic injuries demand immediate life-saving measures, transfer to a trauma centre, appropriate resuscitative care, prompt diagnosis, and surgical intervention by an interdisciplinary team of abdominal, vascular, and cardiac surgeons. If these measures are provided, outcomes are maximized, mortality is minimized, and permanent damage can be avoided.
Publisher

Year
Volume
83
Issue
3
Pages
117-122
Physical description
Dates
published
1 - 3 - 2011
online
2 - 5 - 2011
Contributors
author
  • Department of General, Abdominal and Vascular Surgery, Municipal Hospital, Halberstadt, Germany
author
  • Department of General, Abdominal and Vascular Surgery, University Hospital, Magdeburg, Germany
author
  • Department of Heart and Thoracic Surgery, University Hospital, Magdeburg, Germany
author
  • Department of General, Abdominal and Vascular Surgery, University Hospital, Magdeburg, Germany
author
  • Department of General, Abdominal and Vascular Surgery, University Hospital, Magdeburg, Germany
References
  • Reiher H, Peschke G, May G, et al.: Schwere Pfählungsverletzung mit chirurgischer, gynäkologischer und urologischer Primärversorgung. Zentralbl Chir 1990; 115: 1041-43.
  • Funke M, Nies C, Hessmann M, et al.: Pfählungsverletzung von Colon, Vena iliaca und Kreuzbein - eine seltene Kombination bei penetrierendem Abdominaltrauma. Chirurg 1996; 67: 1184-87.
  • Schwickal J, Burkart A, Brandl R: Penetrierendes Trauma der A. femoralis - temporäre Ballonokklusion der infrarenalen Aorta - Falldarstellung. Angio Arch 1994; 26: 108-11.
  • Usath HD: Schwere transthorakale Pfählungsverletzung. Zentralbl Chir 1976; 101: 878-80.
  • Platz A, Sommer C, Heinzelmann M, et al.: Abdominale Pfählungsverletzungen. Unfallchirurg 2001; 104: 399-403.
  • Schreiter D, Scheibner L, Katscher S, et al.: Diagnostik und Therapie der schweren Lungenkontusion. Available at
  • Lippert H, Falkenberg B: Strategie und Taktik bei perinealen Pfählungsverletzungen. Chirurg 2001; 72: 1402-06.
  • Halter G, Ohrend KH: Gefäßverletzungen im Thorax, Abdomen und Becken. Chirurg 2005; 76: 411-26.
  • Bäumer F, Gay B, Markert U, et al.: Problematik und Häufigkeit abdominoperinealer Pfählungsverletzungen. Unfallchirurg 1990; 93: 212-15.
  • Thomas DD, Levison MA, Dykstra BS, et al.: Management of rectal injuries. Dogma versus practice. Am Surg 1990: 56: 507-10.
Document Type
Publication order reference
Identifiers
YADDA identifier
bwmeta1.element.-psjd-doi-10_2478_v10035-011-0019-3
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