Tension hemothorax due to iatrogenic subclavian artery perforation: Hybrid management of a very rare complication.

BACKGROUND: Tension hemothorax is a rare event, due to different causes: trauma, ruptured thoracic aorta aneurysms, or as a complication of central venous line placement due to inadvertent artery puncture or cannulation. Tension hemothorax leads to both hypovolemic and obstructive shock and can require emergency management. PRESENTATION OF CASE: A 63 years old lady underwent a complicated surgical procedure for a postoperative small bowel obstruction after radical cystectomy. During the procedure, a central venous catheter was placed, under ultrasound guidance, in the right jugular vein but an unknown puncture of the right subclavian artery occurred. In the early phase of the postoperative course, a hypovolemic/obstructive shock developed because of a tension hemothorax. The patient underwent an emergency thoracotomy in the hybrid room, followed by an endovascular repair of the arterial laceration. A recurrent hemothorax developed a few hours later because of an endoleak that was treated successfully with a second endovascular approach and a balloon dilatation of the stent. CONCLUSIONS: tension hemothorax due to inadvertent subclavian artery laceration can be life-threatening and should be managed in a hybrid room with endovascular and surgical capabilities.

A standardised and simplified technique for laparoscopic resection of the splenic flexure.

The splenic flexure is an uncommon location of colorectal cancer, being involved in 2%-3% of cases. The low chance of being engaged in resecting cancer of the splenic flexure can make it difficult for surgeons to build their learning curve and to achieve a reliable experience. As the majority of colectomies are still performed by low-volume surgeons, there is growing agreement that providing local services with adequate surgical education and training could be an effective strategy to improve outcomes and global health. Arming surgeons with simplified and easy-to-learn surgical techniques could be an important step of this strategy. A novel simplified technique for laparoscopic resection of the splenic flexure is presented, which combines laparoscopic mobilisation of the right colon with extracorporeal vascular ligation and bowel anastomosis.