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Timing and order of surgeries for thoracic trauma with multiple injuries: A case report

The timing and order of multiple surgeries for patients with multiple thoracic injuries have not been standardized. A 75-year-old man, who was injured because of a closing elevator door, underwent intubation, bilateral chest drain insertion, and massive blood transfusion due to shock and respiratory...

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Autores principales: Yahagi, Ryuta, Igarashi, Yutaka, Inoue, Tatsuya, Miyake, Nodoka, Kim, Shiei, Yokobori, Shoji
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8889233/
https://www.ncbi.nlm.nih.gov/pubmed/35252527
http://dx.doi.org/10.1016/j.tcr.2022.100625
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author Yahagi, Ryuta
Igarashi, Yutaka
Inoue, Tatsuya
Miyake, Nodoka
Kim, Shiei
Yokobori, Shoji
author_facet Yahagi, Ryuta
Igarashi, Yutaka
Inoue, Tatsuya
Miyake, Nodoka
Kim, Shiei
Yokobori, Shoji
author_sort Yahagi, Ryuta
collection PubMed
description The timing and order of multiple surgeries for patients with multiple thoracic injuries have not been standardized. A 75-year-old man, who was injured because of a closing elevator door, underwent intubation, bilateral chest drain insertion, and massive blood transfusion due to shock and respiratory distress. Computed tomography showed hemopneumothorax with extravasation, tracheobronchial injury, aortic injury, thoracic vertebral anterior dislocation, and multiple rib fractures. He was hospitalized and underwent embolization on the day of admission. Next, veno-venous extracorporeal membrane oxygenation (VV-ECMO) was conducted to address severe respiratory failure. The most crucial aspect of the management was treating the tracheobronchial injury because weaning the patient off the VV-ECMO depended on the success of the repair. Thus, the tracheobronchial repair was performed 7–10 days after injury. A right intrathoracic hematoma removal was performed on the third day and a thoracic endovascular aortic repair on the fifth day. The tracheobronchial repair was performed on the ninth day followed by the posterior thoracic fusion on the 18th day. The patient was successfully weaned off the VV-ECMO and mechanical ventilation on the 24th and 46th days, respectively. Early surgery is not always ideal when managing thoracic trauma cases involving multiple sites. Rather, the treatment should be individualized, and the essential surgical procedures should be timed appropriately.
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spelling pubmed-88892332022-03-03 Timing and order of surgeries for thoracic trauma with multiple injuries: A case report Yahagi, Ryuta Igarashi, Yutaka Inoue, Tatsuya Miyake, Nodoka Kim, Shiei Yokobori, Shoji Trauma Case Rep Case Report The timing and order of multiple surgeries for patients with multiple thoracic injuries have not been standardized. A 75-year-old man, who was injured because of a closing elevator door, underwent intubation, bilateral chest drain insertion, and massive blood transfusion due to shock and respiratory distress. Computed tomography showed hemopneumothorax with extravasation, tracheobronchial injury, aortic injury, thoracic vertebral anterior dislocation, and multiple rib fractures. He was hospitalized and underwent embolization on the day of admission. Next, veno-venous extracorporeal membrane oxygenation (VV-ECMO) was conducted to address severe respiratory failure. The most crucial aspect of the management was treating the tracheobronchial injury because weaning the patient off the VV-ECMO depended on the success of the repair. Thus, the tracheobronchial repair was performed 7–10 days after injury. A right intrathoracic hematoma removal was performed on the third day and a thoracic endovascular aortic repair on the fifth day. The tracheobronchial repair was performed on the ninth day followed by the posterior thoracic fusion on the 18th day. The patient was successfully weaned off the VV-ECMO and mechanical ventilation on the 24th and 46th days, respectively. Early surgery is not always ideal when managing thoracic trauma cases involving multiple sites. Rather, the treatment should be individualized, and the essential surgical procedures should be timed appropriately. Elsevier 2022-02-21 /pmc/articles/PMC8889233/ /pubmed/35252527 http://dx.doi.org/10.1016/j.tcr.2022.100625 Text en © 2022 The Authors. Published by Elsevier Ltd. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Yahagi, Ryuta
Igarashi, Yutaka
Inoue, Tatsuya
Miyake, Nodoka
Kim, Shiei
Yokobori, Shoji
Timing and order of surgeries for thoracic trauma with multiple injuries: A case report
title Timing and order of surgeries for thoracic trauma with multiple injuries: A case report
title_full Timing and order of surgeries for thoracic trauma with multiple injuries: A case report
title_fullStr Timing and order of surgeries for thoracic trauma with multiple injuries: A case report
title_full_unstemmed Timing and order of surgeries for thoracic trauma with multiple injuries: A case report
title_short Timing and order of surgeries for thoracic trauma with multiple injuries: A case report
title_sort timing and order of surgeries for thoracic trauma with multiple injuries: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8889233/
https://www.ncbi.nlm.nih.gov/pubmed/35252527
http://dx.doi.org/10.1016/j.tcr.2022.100625
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