Penetrating thoracoabdominal injuries: Ongoing dilemma - Which cavity and when?

Juan A. Asensio, Hector Arroyo, William Veloz, Walter Forno, Esteban Gambaro, Gustavo A. Roldan, James Murray, George Velmahos, Demetrios Demetriades

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67 Scopus citations

Abstract

The aims of this study were to (1) define characteristics for the thoracoabdominal injury patient population; (2) describe sequences of surgical interventions with combined procedures (i.e., thoracotomy and laparotomy); and (3) describe pitfalls leading to inappropriate sequencing of surgical interventions for thoracoabdominal injuries. It was a retrospective 4-year study (January 1995 to December 1998) conducted at an urban level I trauma center. The study population comprised 254 patients who had sustained thoracoabdominal injuries requiring surgical intervention: 187 (73%) gunshot wounds (GSWs), 64 (25%) stab wounds (SWs), and 3 (2%) shotgun wounds (STWs). The mean revised (RTS) was 6.04; the mean Injury Severity Score (ISS) was 27; the mean estimated blood loss (EBL) was 3000 mi. The overall survival was 175 of 254 (69%). Of the 254, 51 (20%) underwent emergency department (ED) thoracotmy. Altogether, 73 (29%) underwent combined thoracotomy and laparotomy: 59 (81%) GSW, 13 (18%) SW, 1 (1%) STW (mean RTS 5.2, mean ISS 34, mean EBL 6800 mi). Overall survival was 30 of these 73 (41%). A total of 21 of the 73 (29%) underwent ED thoracotomy. In group I laparotomy then thoracotomy: Lap + Thor, n = 34) the initial procedure was interrupted in 18 (53%). In group II (thoracotomy then laparotomy: Thor + Lap, n = 39) the initial procedure was interrupted in 14 (36%). Pitfalls leading to inappropriate surgical sequencing were persistent hypotension (13/73, 18%) and misleading chest tube output (8/73, 10%). It was concluded that penetrating thoracoabdominal injuries incur high mortality (31%), and the mortality doubles for patients who require combined procedures (59%). Inappropriate surgical sequencing occurred in 32 of 73 (44%) patients undergoing combined procedures. Persistent hypotension, indicating that the wrong cavity was accessed, and misleading chest tube output are the leading pitfalls in thoracoabdominal injury management.

Original languageEnglish
Pages (from-to)539-543
Number of pages5
JournalWorld Journal of Surgery
Volume26
Issue number5
DOIs
Publication statusPublished - May 2002
Externally publishedYes

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All Science Journal Classification (ASJC) codes

  • Surgery

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Asensio, J. A., Arroyo, H., Veloz, W., Forno, W., Gambaro, E., Roldan, G. A., ... Demetriades, D. (2002). Penetrating thoracoabdominal injuries: Ongoing dilemma - Which cavity and when? World Journal of Surgery, 26(5), 539-543. https://doi.org/10.1007/s00268-001-0147-8