Management of combined penetrating cardiac and abdominal trauma.
This is a retrospective review of patients with combined penetrating cardiac and abdominal trauma. Clinical presentation patterns are described and a management strategy is outlined. The series comprises 25 patients. On the basis of the mechanism of injury and the prognosis, the patients were divided into two groups: 'low risk' (single high epigastric stab wound) and 'high risk' (multiple stabs, single or multiple gunshot wounds). There were six patients in the low-risk group. Their intra-abdominal injuries were moderately severe. None of this group died. There were 19 patients in the high-risk group. Three underwent emergency-room thoracotomy and died. Of the remaining patients, four underwent a thoracotomy first for cardiac tamponade or massive haemothorax and 12 underwent a laparotomy first because of massive haemoperitoneum. The mortality in this group was 63 per cent. It is essential to recognize the cardiac injury in low-risk patients; the cardiorrhaphy must be performed before the laparotomy. In high-risk patients, the sequence of operations depends on the clinical presentation. Obvious cardiac tamponade or massive haemothorax mandate a thoracic approach first, while severe hypovolaemic shock with a massive haemoperitoneum justifies the performance of a laparotomy first; a transdiaphragmatic pericardiotomy is useful, in these cases, before proceeding to median sternotomy.
Department of Surgery, Baragwanath Hospital, Johannesburg, South Africa.
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Saadia
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Degiannis
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RD
Levy
D000007:Abdominal Injuries / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D005260:Female; D006335:Heart Injuries / Q000601:surgery*; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013908:Thoracotomy; D014948:Wounds, Gunshot / Q000601:surgery; D014950:Wounds, Penetrating / Q000601:surgery*; D014951:Wounds, Stab / Q000601:surgery