Subxiphoid pericardial window to exclude occult cardiac injury after penetrating thoracoabdominal trauma.
BACKGROUND
An occult cardiac injury may be present in patients with an acute abdomen after penetrating thoracoabdominal trauma. This study assessed the use of a subxiphoid pericardial window (SPW) as a diagnostic manoeuvre in this setting.


METHODS
This was a retrospective review of a trauma database (2001-2009). Patients presenting with a penetrating thoracoabdominal injury with an acute abdomen, and in whom there was concern about a potential cardiac injury from the site or tract of the injury, were included.


RESULTS
Fifty patients with an indication for emergency laparotomy underwent a SPW for a possible cardiac injury. An occult haemopericardium was present at SPW in 14 patients (28 per cent) mandating, median sternotomy. Nine cardiac injuries (18 per cent) were identified including five tangential injuries and four perforations. The specific complication rate relating to the SPW was 2 per cent.


CONCLUSIONS
The SPW is a useful technique at laparotomy to identify cardiac injuries in patients with penetrating thoracoabdominal injuries.
Trauma Centre, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
M
M
Hommes
A J
AJ
Nicol
J
J
van der Stok
I
I
Kodde
P H
PH
Navsaria
D000007:Abdominal Injuries / Q000175:diagnosis / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D003106:Colon / Q000293:injuries / Q000601:surgery; D005260:Female; D006335:Heart Injuries / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008099:Liver / Q000293:injuries / Q000601:surgery; D008297:Male; D010491:Pericardial Window Techniques; D012189:Retrospective Studies; D013270:Stomach / Q000293:injuries / Q000601:surgery; D013898:Thoracic Injuries / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000601:surgery*; D055815:Young Adult