Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 10 , ISSUE 2 ( May-August, 2021 ) > List of Articles

Original Article

Traumatismo Toracoabdominal Penetrante: Que Cavidad Operar Primero?

Celeste Echavarria, Sofia Bou, Favio Guzman, Cristian Assell, Juliana Nazaretto, Andrea Potes, Guillermo Barillaro

Keywords : Abdominal penetrating trauma, Decision making, Mortality analysis, Open thoracic trauma, Quality in trauma management, Ultrasonography

Citation Information : Echavarria C, Bou S, Guzman F, Assell C, Nazaretto J, Potes A, Barillaro G. Traumatismo Toracoabdominal Penetrante: Que Cavidad Operar Primero?. Panam J Trauma Crit Care Emerg Surg 2021; 10 (2):71-77.

DOI: 10.5005/jp-journals-10030-1318

License: CC BY-NC 4.0

Published Online: 00-08-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Patients with penetrating thoracoabdominal trauma (PTAT) by gunshot wounds (GSW) or by stab wounds (SW) pose the challenge of deciding which cavity to operate first. Initiating surgery in the cavity with less severe injuries may delay the management of a fatal hemorrhage or cardiac tamponade. Aim and objective: The objective of this work was the analysis of: • Characteristics of patients with PTAT with a sequence of combined surgical interventions. • Characteristics of the error due to inappropriate sequence of said operative procedures. • Relationship of these previous factors with mortality. Design: Observational retrospective. Materials and methods: Review of the medical records of the patients assisted in our institution between January 2005 and December 2018, with PTAT that required operative procedures both in the chest (pleural drainage or thoracotomy) and in the abdomen (laparotomy or laparoscopy). Results: Seventy-nine patients with PTAT, 48 with normal hemodynamics (group I) and 31 with hypovolemic shock (group II) were assisted. In group I, SW (40) predominated over GSW (8), and lesions on the left side (42) (87.5%). In this group, there were no errors in sequential surgical management and no mortality was recorded. In group II, transfixing GSW of the midline predominated. In eight cases, an error was recorded when first approaching the cavity with less serious injuries (in four cases the thorax and in four cases the abdomen), seven of them died and determining mortality of 25.8% for group II. The analysis of the error in these eight cases found that in five it was potentially preventable and that it was related to erroneous results of the ultrasound and/or underestimation of the output of the pleural drainage and of the post-pleural drainage chest radiograph. Conclusion: Patients with PTAT and hemodynamically compensated presented a predominance of left-sided SW and had no errors in the sequential management of cavities or mortality. On the other hand, in those with PTAT and shock, GSW and transfixing paths of the midline predominated, and this group was the one that had exclusively the handling errors and mortality. Most of the errors in management were considered potentially preventable since they were related to false results of the ultrasound and underestimation of the output of the pleural drainage and of the post-pleural drainage chest radiograph.


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