Ainhoa Aixa Maestu Fonseca (Cadiz / ES), Sergio Darley León Castro (Cali / CO), Helio Fernando Espinosa Cadavid (Cali / CO)
Case history: Forthy-nine years old male is taken into the emergency room 30 minutes after a stab wound in the right supraclavicular region.
Clinical findings: Airway was patent, decreased lung sounds in right hemithorax with 85% oxygen saturation and respiratory rate of 25 rpm. Blood pressure was 50/34 and hearth rate 127 bpm. Glasgow coma scale was 13/15. An active bleeding was detected from the supraclavicular wound.
Investigation/Results: Extended eco-Fast was performed confirming right hemopneumothorax, and remaining negative in the rest of the windows.
Diagnosis: The patient is diagnosed as a grade II-III of the thoracic vascular trauma injury scale of the American Association of Trauma.
Therapy and Progressions: Massive transfusion protocol is activated. Foley catheter is inserted for local control of bleeding. The patient is transfer to the operation room. A sternotomy with right supraclavicular extension is performed. The bleeding is controlled and hemothorax is drainage. An injury of the right internal jugular vein and some tributaries as an injury of the right mammary artery ats its origin are observed.Unexplained desaturation is reported. An airway injury is suspected. A 2 cm injury in the right lateral wall of the trachea is observed and repair with simple stitches con vycril 3.0. Oesophagus is examine without pathological findings.
The total blood loos is 3.500 cc and the patients requires vasoactive support so a damage control surgery is done. The patient spent 72h in the ICU correcting metabolically alterations. After this is taken operation room where no tracheal airleaks or bleeding are seen. Chest cavity is close. Patient is discharge from hospital in the 7th postoperative day.
Comments: Supraclavicular stab wounds may present with vascular, airway and digestive tract injuries. It"s important to examine all structures before ending surgery.
References: Millán M, Ordoñez CA, Parra MW. Guía práctica para el abordaje quirúrgico del trauma penetrante del torso en paciente hemodinámicamente inestable. Colomb Méd (Cali), 2021; 52(2)
No
We use cookies on our website. Cookies are small (text) files that are created and stored on your device (e.g., smartphone, notebook, tablet, PC). Some of these cookies are technically necessary to operate the website, other cookies are used to extend the functionality of the website or for marketing purposes. Apart from the technically necessary cookies, you are free to allow or not allow cookies when visiting our website.