ABSTRACT
To report a case of penetrating cardiac injury with patients survival. A 23-year-old man stabbed with a knife to the epigastric area just below the right costal margin was brought to the Emergency Room, AI-Adan Hospital, Kuwait, in a state of shock. Aggressive resuscitation was performed, chest X-ray showed no evidence of hemo- or pneumothorax. Exploratory laparotomy was performed revealing a severely congested liver, with no intraperitoneal hemorrhage to explain his being in a state of shock. Left thoracotomy revealed pericardial tamponade with perforation in the right ventricle and hemorrhage. A mattress suture was used to control bleeding from the right ventricle. Postoperative echography revealed a tear in the interventricular septum and papillary muscle. Open-heart surgery was performed to repair the injured tissues. The patient made an uneventful recovery. This report shows that patients with penetrating cardiac injuries and detectable vital signs on arrival at the hospital can be salvaged by prompt surgical intervention.
Subject(s)
Humans , Male , Emergency Medical Services , Violence , Wounds, Stab/surgeryABSTRACT
To report a case of splenic artery aneurysm that ruptured during labor with both maternal and fetal survival. Clinical Presentation and Intervention: A 33-year-old primigravida at 42 weeks of gestation was admitted to Adan Hospital for induction of labor. Three days after induction, the patient suddenly collapsed and was found to be hypotensive. Abruptio placentae was mistakenly diagnosed, despite the absence of vaginal bleeding, and the patient was immediately taken to the operating room for emergency cesarean section. A female infant was delivered without any evidence of abruptio placentae but with 2,000 ml blood noted in the abdominal cavity. A vertical midline incision was performed and a ruptured splenic artery aneurysm was found. Proximal ligation of the splenic artery was performed followed by splenectomy. Both mother and newborn did well and were discharged on the 7th postoperative day. This case illustrates the need to consider ruptured splenic artery aneurysm as part of differential diagnosis of hemoperitoneum in pregnant women. Immediate surgical intervention is needed to ensure survival of both mother and fetus.