Victor Y Kong1, Damian L Clarke2. 1. Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg 3216, South Africa. Electronic address: victorywkong@yahoo.com. 2. Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg 3216, South Africa. Electronic address: damianclar@gmail.com.
Abstract
INTRODUCTION: Iatrogenic visceral injuries (IVI) secondary to the insertion of an intercostal chest drain (ICD) are well documented, but are usually confined to case reports and small series. MATERIALS AND METHODS: We reviewed our experience with 53 consecutive patients over a insertion seven year period who sustained an IVI secondary to an ICD and describe the spectrum of injuries and clinical outcome in a high volume trauma service in South Africa. RESULTS: A total of 53 ICDs were inserted in 53 patients, 83% (44/53) of which were on the left side, and 17% (9/53) on the right side. 92% (49/53) of the patients were males and the mean age for all patients was 24 (±8) years. 85% of the patients were referred from rural hospitals, the remaining 15% were treated initially at our institution. A trocar was used in 75% (40/53) of patients and in 9% (5/53), a trocar was not used, 58 organ injuries occurred in 53 patients. 92% (49/53) of patients sustained a single organ injury and 4 sustained multiple injuries. The three most common injuries were: diaphragm (36%, 21/53), gastric (22%, 13/53), and pulmonary (12%, 7/53). Other injuries were: 6 (10%) spleen, 4 (7%) liver, 2 (3%) colon and 1 (2%) kidney. Three (5%) sustained an injury to the intercostal artery and one (2%) sustained a pulmonary artery injury. 39 patients (74%) required operative interventions which included laparoscopy: 20 (51%), laparotomy: 8 (21%), thoracotomy: 8 (21%), VAT: 3 (8%). A total of 28 patients (53%) developed further complications: 13 wound sepsis, 7 pneumonia, 6 empyema, 2 ARDS. and 15% (8/53) required intensive care admission. The mean length of hospital stay was 7 (±4) days. CONCLUSIONS: IVI is associated with significant morbidity, with diaphragmatic, gastric and pulmonary injuries being the most common. The majority were inserted in the rural hospitals and were associated with use of a trochar, Level of evidence: III, Study type: Retrospective study.
INTRODUCTION:Iatrogenic visceral injuries (IVI) secondary to the insertion of an intercostal chest drain (ICD) are well documented, but are usually confined to case reports and small series. MATERIALS AND METHODS: We reviewed our experience with 53 consecutive patients over a insertion seven year period who sustained an IVI secondary to an ICD and describe the spectrum of injuries and clinical outcome in a high volume trauma service in South Africa. RESULTS: A total of 53 ICDs were inserted in 53 patients, 83% (44/53) of which were on the left side, and 17% (9/53) on the right side. 92% (49/53) of the patients were males and the mean age for all patients was 24 (±8) years. 85% of the patients were referred from rural hospitals, the remaining 15% were treated initially at our institution. A trocar was used in 75% (40/53) of patients and in 9% (5/53), a trocar was not used, 58 organ injuries occurred in 53 patients. 92% (49/53) of patients sustained a single organ injury and 4 sustained multiple injuries. The three most common injuries were: diaphragm (36%, 21/53), gastric (22%, 13/53), and pulmonary (12%, 7/53). Other injuries were: 6 (10%) spleen, 4 (7%) liver, 2 (3%) colon and 1 (2%) kidney. Three (5%) sustained an injury to the intercostal artery and one (2%) sustained a pulmonary artery injury. 39 patients (74%) required operative interventions which included laparoscopy: 20 (51%), laparotomy: 8 (21%), thoracotomy: 8 (21%), VAT: 3 (8%). A total of 28 patients (53%) developed further complications: 13 wound sepsis, 7 pneumonia, 6 empyema, 2 ARDS. and 15% (8/53) required intensive care admission. The mean length of hospital stay was 7 (±4) days. CONCLUSIONS: IVI is associated with significant morbidity, with diaphragmatic, gastric and pulmonary injuries being the most common. The majority were inserted in the rural hospitals and were associated with use of a trochar, Level of evidence: III, Study type: Retrospective study.
Authors: Yoginee Sritharen; Matthew C Hernandez; Nadeem N Haddad; Victor Kong; Damian Clarke; Martin D Zielinski; Johnathon M Aho Journal: World J Surg Date: 2018-03 Impact factor: 3.352
Authors: Matthew C Hernandez; David Vogelsang; Jeff R Anderson; Cornelius A Thiels; Gregory Beilman; Martin D Zielinski; Johnathon M Aho Journal: Injury Date: 2017-02-20 Impact factor: 2.586