HEMOTHORAX FOLLOWING PENETRATING THORACIC INJURY (GUNSHOT WOUND) IN GERIATRIC PATIENT: A CASE REPORT AND EMERGENCY MANAGEMENT

Gerardo AK Laksono, Ferdinand Erwin, Dyana Sarvasti, Paul L Tahalele

Abstract


Introduction: Penetrating chest trauma is highly lethal. Studies have reported up to 60%
mortality depending on the mechanism of injury. While penetrating chest trauma is less
common than blunt trauma, it can be more deadly. High-velocity gunshot injury resulting in
penetrating thoracic trauma in geriatric patients poses a significant challenge for the traumatic
surgeon. Hemothorax is usually a consequence of penetrating chest trauma. It can be caused by
intercostal arterial bleeding, especially the posterior part. Initial treatment, including chest tube
drainage insertion, is needed to avoid lung compression and to assess future treatment needed.
Purpose: To report the patient survival from massive hemothorax caused by penetrating
Thoracic injury caused by an air rifle, treated by chest tube insertion and posterolateral
thoracotomy to take out the bullet several days after.
Case Report: 70-year male patient came to the Emergency Room (ER) Adihusada Hospital
Surabaya with a penetrating chest injury caused by an air rifle on the right side of the chest.
The patient had chest pain, shortness of breath, and hypoxia. By inserting a chest tube,
emergency management was done by a general surgeon due to the massive right hemothorax.
An immediate chest tube insertion was needed to overcome the patient’s breathing problem to
assess the future treatment needed. Chest X-ray and CT-Scan was done immediately after the
patient’s hemodynamic were stable. Three days after hospitalizing, the Cardiothoracic and
vascular surgeon performed posterolateral thoracotomy to take the bullet out of the chest.
Conclusion: Seven days postoperatively, the patient was discharged from the hospital without
any complications and stable hemodynamic. The patient went to the outpatient department for
follow-up one week after.


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Keywords


Chest injury; penetrating chest injury; gunshot injury; hemothorax

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References


Onat, S., Ulku, R., Avci, A., Ates, G. & Ozcelik, C. Urgent thoracotomy for penetrating chest trauma: Analysis of 158 patients of a single center. Injury 42, 900–904 (2011).

Ludwig, C. & Koryllos, A. Management of chest trauma. J.

Thorac. Dis. 9, S172–S177 (2017).

Unsworth, A., Curtis, K. & Asha, E. E. Treatments for blunt chest trauma and their impact on patient outcomes and health service delivery. Scand. J.Trauma. Resusc. Emerg. Med. 23, 1–9 (2015).

Ekpe, E. E. & Eyo, C. Determinants of mortality in chest trauma patients. Niger. J. Surg. Off. Publ. Niger. Surg. Res. Soc. 20, 30–34 (2014).

Karmy-Jones, R. et al. Urgent and Emergent Thoracotomy for Penetrating Chest Trauma. J. Trauma - Inj. Infect. Crit. Care 56, 664–668 (2004).

Ilhan Inci, C. et al. Penetrating chest injuries: Unusually high incidence of high-velocity gunshot wounds in civilian practice. World J. Surg. 22,438–442 (1998).

Benjamin Christie, D., Nowack, T., Drahos, A. & Ashley, D. W. Geriatric chest wall injury: Is it time for a new sense of urgency? J. Thorac. Dis. 11,S1029–S1033 (2019).

Qaqish, T. R., Coleman, J. & Katlic, M. Geriatric Trauma and Acute Care Surgery. Geriatr. Trauma Acute Care Surg. (2018). DOI:10.1007/978-3-31957403-5

Moore, C. et al. Successful treatment of massive hemothorax with class IV shock using aortography with transcatheter embolization of actively bleeding posterior left intercostal arteries after penetrating left chest trauma: A case for the hybrid OR. Int. J. Surg. Case Rep. 48, 109–112 (2018).

Yi, J. H. et al. Management of traumatic hemothorax by closed

thoracic drainage using a central venous catheter. J. Zhejiang Univ. Sci.B 13, 43–48 (2012).

Ika Maylasari, S.ST., M. S. et al. Statistik Penduduk Lanjut Usia 2019. xxvi + 258 halaman (2019).

Arslan, B. Geriatric trauma. Curr.Opin. Crit. Care 21, 520–526 (2015).

McMahon, D. J., Schwab, C. W. & Kauder, D. Comorbidity and the

elderly trauma patient. World J. Surg. 20, 1113–1120 (1996).

Demetriades, D. & Velmahos, G. C. PENETRATING INJURIES OF THE CHEST : INDICATIONS FOR OPERATION. SAGE Journals 91, 41–

injuries: Ten years’ experience at a Dutch level I trauma center. Eur. J.

Trauma Emerg. Surg. 38, 543–551(2012).

Roth, B. J. et al. Penetrating trauma in patients older than 55 years: A casecontrol study.Injury 32,551–554(2001).

Nagy, K. K. et al. Prognosis of penetrating trauma in elderly patients:A comparison with younger patients. J.Trauma - Inj. Infect. Crit. Care 49,190–194 (2000).

Ottochian, M. et al. Does age matter? The relationship between age and mortality in penetrating trauma. Injury 40, 354–357 (2009).

Puruhito. Ilmu Bedah Toraks Primer, Kardiak, dan Vaskular: Buku Ajar. (Airlangga University Press, 2013).

Boersma, W. G., Stigt, J. A. & Smit, H. J. M. Treatment of haemothorax.Respir. Med. 104, 1583–1587 (2010).

Bertoglio, P. et al. Chest drain and thoracotomy for chest trauma. J.

Thorac. Dis. 11, S186–S191 (2019).

Huber-Wagner, S. et al. Emergency chest tube placement in trauma careWhich approach is preferable? Resuscitation 72,226–233

(2007).

Kim, T. J., Goo, J. M., Moon, M. H., 45 (2002). Im, J. G. & Kim, M. Y. Foreign Bodies 15. van Waes, O. J. F., van Riet, P. A., van Lieshout, E. M. M. & Hartog, D. D. Immediate thoracotomy for penetrating

in the Chest: How Come They Are Seen in Adults? Korean J. Radiol. 2,

–96 (2001).

Dienstknecht, T. et al. Indications for bullet removal: Overview of the literature and clinical practice guidelines for European trauma

surgeons. Eur. J. Trauma Emerg. Surg. 38, 89–93 (2012).

Mintz, Y., Gross, M., Rivkind, A. & Eliashar, R. Retained thoracic missile: Should the bullet be removed? J.Trauma - Inj. Infect. Crit. Care 54, 418 (2003).

Erikci, V. S., Mert, M. & Özdemir, T.A Bullet in the Thoracic Wall

Following Gun Shot Wound : A Case Report and Review of Literature. 2, 7–9 (2019).




DOI: https://doi.org/10.33508/jwmj.v3i2.3180

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