The challenges of penetrating thoracoabdominal trauma – A case report

Abstract text (incl. references and figure legends)

Introduction:Penetrating thoracoabdominal trauma is a fairly common occurrence in the ER. It is associated with potencial damage to both the abdominal and thoracic cavity. It is usualy caused by a stab wound or a gunshot. The most commonly affected abdominal organs are the bowel, liver and spleen. The involvement of the diaphragm must always be evaluated. The severity of the injury is dependent on the organs involved, the characteristics of the object, and the amount of energy transmitted. Case Report:We presente a case of a 44-years-old male with no previous medical history, taken to the ER after penetrating thoracoabdominal trauma involving a knife wound. A CT-scan was performed demontrating: "bladed weapon embedded in the left dorsolumbar transition, through the last left intercostal space with mild densification of the perirenal planes. Discrete underlying hemopneumothorax on the left and small focus that may correspond to a splenic parenchymal laceration, presumably coexisting with small hemoperitoneum." A subcostal explorative laparotomy was performed and the knife was removed under direct visualization. Diaphragm laceration was identified and primarily repaired. A grade II spleen laceration was revealed and successfully contained with compression and a surgical absorbable hemostat. Thorax drainage was performed. The postoperative period was uneventful. Conclusion:Penetrating thoracoabdominal trauma presents substantial clinical challenges as it can lead to complex and life-threating conditions, so appropriate management is of the utmost importance. When managing a patient with penetrating thoracoabdominal trauma, evaluation of the patient"s hemodynamic condition is fundamental. The high incidence of bowel and diaphragmatic involvement ultimately limits nonoperative management. Futhermore, the assessment of the diaphragm, identification of a possible laceration and its repair is essencial in the prevention of future complications, namely diaphragmatic hernias.

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