title: [Temporary treatment of uncontrolled intrathoracic hemorrhaging with abdominal towels in combination with a rescue procedure. Damage control procedure of the chest].
abstract: Case report of a 27-year-old patient who presented with a stab wound in the posterior aspect of the right chest. The patient was physiologically unstable and not responding to fluid resuscitation. A right intercostal drainage was inserted which immediately drained 1100 ml of blood. Thoracotomy was performed where a large clot was removed from the pleural cavity and followed by massive bleeding from the hilum of the lung as well as an intercostal artery posteriorly. Control of the hilar hemorrhaging necessitated right middle lobe resection. Attempts to control the bleeding from the intercostal artery were futile becoming technically more difficult due to a comminuted fracture of the ribs at the site of entry of the knife. During these attempts the patient became moribund. As a last resort the pleural cavity was packed with abdominal towels and the patient was transferred to the intensive care unit (ICU). The patient was returned to surgery after 48 h at which time the packing was removed with no further bleeding. On day 11 postoperatively drainage of the pleural collection was carried out and decortication of the right lower lobe. The patient was discharged 23 days after admission in a good general condition. This case report demonstrates that in exceptional circumstances packing of the pleural cavity to control bleeding can be considered as a method of damage control in penetrating chest trauma.
authors.affiliation: Department of Surgery, University of Ankara, Ankara, Turkey.
authors.forename: T H
authors.initials: TH
authors.lastname: Yilmaz
authors.forename: E
authors.initials: E
authors.lastname: Degiannis
authors.forename: D
authors.initials: D
authors.lastname: Doll
mesh_terms: D000328:Adult; D001458:Bandages; D003422:Critical Care / Q000379:methods; D006470:Hemorrhage / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D013898:Thoracic Injuries / Q000150:complications* / Q000628:therapy*; D016896:Treatment Outcome; D014951:Wounds, Stab / Q000150:complications* / Q000628:therapy*