Abstract text (incl. references and figure legends)
Case History
A seventy year old man, with no prior relevant medical history was admitted in the emergency room after agression from a shotgun from behind from 3 meters.
Clinical Findings
At admission, with ACS Class III hemorragic shock,tachycardia, polypnea, and 2L estimated blood loss.
The entry point was in the posterior left hemithorax with 5 cm diâmeter, just inferior the the last ribs and other more disperse, laceration wounds, compatible with entry point from several leads.
Diagnosis
Thoracoabdominal CT scan with contrast showed a left hemothorax, with multiple leads in renal, perigastric and splenic region with no evident active hemorrhage or hemoperitoneum.
Therapy and Progressions
After inicial chest drain, with a 2000 cc hemothorax drainage and preoperative resuscitation, went to the operation room with General and Plastic surgery , where inicial faecal peritonitis was identified with multiple intraabdominal leads and AAST grade V splenic , grade III pancreatic and grade IV Splenic flexure colon injury which lead to Hartmann´s surgery, Distal pancreatectomy and Splenectomy. Plastic surgery executed a Latissimus Dorsi Myocutaneous flap after thorough debridement work. Fifteen days later the patient was diagnosed with a piothorax and Thoracic went to the OR for VATS debridement. After a prolonged hospitalization for antibiotherapy and complementary negative pressure wound therapy the patient was discharged.
Comments
Multidisciplinary approach from General, Plastic, Thoracic surgery and Intensive Medicine was the cornerstone for positive outcome in the management of this particular trauma patient, and shows the advantages of tertiary care facilities.
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