Surgical repair of a liver injury in a patient: accompanied with tricuspid regurgitation.
A 42-year-old man with acute myocarditis developed a right lung abscess and tricuspid regurgitation with valvular vegetations. A chest tube was inserted from the 8th intercostal space on the anterior axillary line to drain acute thoracic empyema caused by rupture of the lung abscess. Six hours after the insertion, the patient went into shock. Since abdominal ultrasonography showed intraabdominal bleeding, an urgent laparotomy was performed. A large amount of blood was present in the peritoneal cavity. Pulsatile bleeding from the hepatic laceration and penetration of diaphragm were observed. Mattress sutures were used to close the hepatic laceration and the rent in the right hemi-diaphragm. Because the patient was hemodynamically stable postoperatively tricuspid valvular replacement was performed 5 days after the laparotomy. Four months after valve replacement, the patient is in good condition without any complaints.
Department of Gastroenterological and Hepato-Biliary-Pancreatic Surgery, Osaka City University, Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan. m8827074@msic.med.osaka-cu.ac.jp
Shogo
S
Tanaka
Kazuhiro
K
Hirohashi
Takahiro
T
Uenishi
Shigehumi
S
Suehiro
Toshihiko
T
Shibata
Shoji
S
Kubo
Hiromu
H
Tanaka
Taichi
T
Shuto
Shigekazu
S
Takemura
Hiroaki
H
Kinoshita
D000328:Adult; D015505:Chest Tubes / Q000009:adverse effects; D003964:Diaphragm / Q000293:injuries; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery*; D022125:Lacerations / Q000209:etiology / Q000601:surgery*; D008099:Liver / Q000293:injuries*; D008297:Male; D013536:Suture Techniques; D013907:Thoracostomy / Q000009:adverse effects*; D014262:Tricuspid Valve Insufficiency / Q000150:complications* / Q000601:surgery