Blunt and penetrating thoracic trauma: management strategy and short-term outcome

To review our experience with blunt and penetrating chest injuries that required surgical interventions. Retrospective case series. Six general hospitals in Kuwait. One hundred fifty nine patients who underwent emergency surgery for thoracic trauma. Urgent thoracic surgical procedures [thoracotomy or sternotomy]. Pattern of injuries, indications for surgery, surgical approaches, short-term morbidity and mortality. One hundred fifty-nine patients [68 with blunt and 91 with penetrating injuries] underwent thoracotomy or sternotomy between January 1995 and December 2006. The mean age was 27 years [range: 2-70 years]. The causes of penetrating injuries were stab wounds [n = 65], gunshot wounds [n = 19] and iatrogenic [n = 7]. The causes of blunt thoracic injuries were motor vehicle accidents [n = 63] and fall from height [n = 5]. The indications for thoracotomy were hemorrhage [n = 115], airway disruption [n = 14], pericardial tamponade [n = 5], clotted hemothorax [n = 8] and diaphragmatic rupture [n = 17]. Major lung resections were performed in four patients [2.5%]. The morbidity was 10 / 159 [6%] and the mortality was 7 / 159 [4.4%]. The majority of deaths were due to adult respiratory distress syndrome [ARDS]. Prompt thoracotomy can be performed with minimal morbidity and mortality in cases of blunt and penetrating thoracic injuries. The complex pattern of such injuries requires a detailed assessment and management by a thoracic surgeon

Spontaneous pneumothorax in a patient with complex bullous lung disease after blunt trauma: a case report

The management of spontaneous pneumothorax [SP] in a patient with complex bullous lung disease may be difficult initially. We report a 32-year-old man who presented to the emergency room with head injury after blunt trauma. The patient had a clinical evidence of SP without chest trauma. He was managed initially with a chest tube but later required surgical intervention to stop the air leak

Right-sided pericardio-diaphragmatic rupture with complete liver and partial heart herniation after blunt trauma

Rupture of the diaphragm and pericardium is an uncommon injury, most frequently caused by high velocity trauma. We present a rare case of right-sided pericardio-diaphragmatic rupture [PDR] with complete herniation of the liver which prevented the complete herniation of the heart. Diagnostic pitfalls and possible mistakes in the treatment strategy are discussed

Pulmonary complications following major lung resection for benign and malignant lung diseases

To assess the incidence and to identify the possible associated risk factors for postoperative pulmonary complications after major lung resection. One hundred and sixty-eight consecutive patients undergoing major lung resection for benign and malignant lung disease over a 3-year period were included in the study. Preoperative assessment clinical parameters, intraoperative and postoperative events were recorded. Pulmonary complications were noted according to a precise definition. The risk of complications associated with age, comorbidity, forced vital capacity [FVC], blood transfusion and extended operation was evaluated using logistic regression analysis. The mean age of the patients was 47.1 years [range 16-80 years], 137 [77%] patients underwent lobectomy, 23 [14%] pneumonectomy, and 15 [9%] bilobectomy. Forty-six [27%] patients developed postoperative pulmonary complications and 2 [1.1%] died within 30 days following the operation. Age =/>65 years [OR 3.7, 95% CI: 1.5-8.6, p = 0.002], the presence of comorbid cardiopulmonary disease [OR 0.2, 95% CI: 0.1-0.5, p = 0.001], FVC <50% [OR 0.2, 95% CI: 0.1-0.8, p = 0.02], blood transfusion [OR 0.2, 95% CI: 0.1-0.4, p = 0.0001], and extended operation [OR 0.2, 95% CI: 0.07-0.6, p = 0.005] were the identified factors associated with the development of postoperative pulmonary complications, which necessitated an increased length of hospital stay. Postoperative pulmonary complications are more likely to develop in patients with age =/>65 years with comorbid cardiopulmonary disease, FVC <50%, blood transfusion, and extended operation