Surgical management of hemothorax due to blunt chest trauma
Abstract
The OBJECTIVE was to analyze the results of treatment and improvement of surgical management of hemothorax following blunt chest injury.
METHODS AND MATERIALS. Of 398 patients with blunt chest trauma, 84 (21.1 %) had hemothorax. Patients were divided into 4 groups: small hemothorax (<300 ml) – 43 people (51.1 %); medium (300 to 1000 ml) – 27 (32.1 %), large (1000 to 1500 ml) – 10 (11.9 %); and total (>1500 ml) – 4 (4.8 %).The causes were household injuries – in 50 cases (59.5 %) and transport injuries – in 20 cases (23.8 %).
RESULTS. Medium, large and total hemothorax was diagnosed by chest X-rays. Computed tomography was performed in case of severe concomitant injuries, clotted hemothorax and unclear diagnosis. In the Group 1, hemothorax was diagnosed by computed tomography scans only in 12 cases (27.9 %), by ultrasound examination – in 4 cases (9.3 %). Medium and large hemothorax at late admission was removed by pleural puncture in 5 cases. Pleural drainage was performed in 24 patients. Thoracoscopy was performed in 53 patients. In 32 patients (60%) of Groups 1 and 2, thoracoscopy ended only with a revision of the pleural cavity and blood removal. The clotted hemothorax was removed during thoracoscopy in 15 patients of Groups 2, 3 and 4. With total hemothorax, 2 patients underwent thoracotomy for ongoing bleeding. Thoracotomy was performed in 3 patients of Groups 1 and 2 for ruptures of the lung and diaphragm. The cause of hemothorax could be rib fractures in 75 patients (90.4 %), lung rupture in 49 patients (59 %) with hemopneumothorax, damage to the diaphragm in 3 (3.6 %) cases. Surgical hemostasis for ongoing bleeding was required in 7 (8.4%) cases. Thoracoscopy for residual hemothorax after drainage of the pleural cavity was performed in four (4.8%) patients.
CONCLUSION. Surgical management for traumatic hemothorax should be differentiated depending on its volume, the associated injuries, the time from injury to the start of treatment, and the developed complications.
About the Authors
S. A. PlaksinRussian Federation
Plaksin Sergei A., Dr. of Sci. (Med.), Professor, Professor of the Department of Surgery with the course of Cardiovascular Surgery and Invasive Cardiology
Competing Interests:
The authors declare no conflict of interest
D. N. Ponomarev
Russian Federation
Ponomarev Danil N., Resident of the Department of Surgery with a course of Cardiovascular Surgery and Invasive Cardiology
Competing Interests:
The authors declare no conflict of interest
A. J. Sozkov
Russian Federation
Sozkov Artem Ju., Resident of the Department of Surgery with a course of Cardiovascular Surgery and Invasive Cardiology
Competing Interests:
The authors declare no conflict of interest
References
1. Malekpour M, Widom K, Dove J, Blansfield J, Shabahang M, Torres D, Wild JL. Management of computed tomography scan detected hemothorax in blunt chest trauma: What computed tomography scan measurements say? // World J Radiol. 2018. 10(12): 184-189 Doi: 10.4329/wjr.v10.i12.184
2. Корымасов Е.А., Бенян А.С. Оптимизация показаний к торакоскопии при травме грудной клетки // Наука и инновации в медицине. 2017. Т. 1, №5. С. 65-72.
3. Korymasov E.A., Benyan A.S. Optimization of indications for thoracoscopy in chest trauma. Science and innovations in medicine. 2017;. 1 (5):. 65-72 (In Russ.)
4. Даниелян Ш.Н., Абакумов М.М., Вильк А.П., Саприн А.А., Татаринова Е.В. Факторы риска развития гнойных осложнений при повреждениях груди // Хирургия. Журнал им. Н.И.Пирогова. 2015. №.7, С. 13-19. Doi:10.17116/hirurgia2015713-19
5. Danielian ShN, Abakumov MM, Vil'k AP, Saprin AA, Tatarinova EV. Risk factors of suppurative complications in case of thoracic injury. Pirogov Russian Journal of Surgery. 2015; 7:13 19.(In Russ.). Doi:10.17116/hirurgia2015713-19
6. Dogrul B.N., Kiliccalan I., Asci E.S., Peker S.C. Blunt trauma related chest wall and pulmonary injuries: An overview // Chinese Journal of Traumatology. 2020; 23:125e138 Doi:10.1016/j.cjtee.2020.04.003
7. Zeiler J., Idell S., Norwood S., Cook A. Hemothorax: A Review of the Literature // Clin Pulm Med. 2020; 27(1): 1–12. Doi: 10.1097/CPM.0000000000000343.
8. Chou Y.-P., Kuo L.-C., Soo K.-M., Tarng Y.-W., Chiang H.-I., Huang F.-D., Lin H.-L. The role of repairing lung lacerations during video-assisted thoracoscopic surgery evacuations for retained haemothorax caused by blunt chest trauma // European Journal of Cardio-Thoracic Surgery. 2014; 46: 107–111. Doi: 10.1093/ejcts/ezt523
9. Сопуев А.А., Султакеев М.З., Ташиев М.М., Мамбетов А.К., Касымбеков Т.М. Место видеоторакоскопической и видеоассистированной торакоскопической хирургии при остаточном гемотораксе // Научное обозрение. 2021. №1. С.25-31
10. Sopuev A.A., Sultakeev M.Z., Tashiev M.M., Mambetov A.K., Kasymbekov T.M. Place of video-assisted and video-assisted thoracoscopic surgery in residual hemothorax. Scientific Review. 2021; 1:25-31 (In Russ.).
11. Chang S.W., Ryu K.M., Ryu J.-W. Delayed massive hemothorax requiring surgery after blunt thoracic trauma over a 5-year period: complicating rib fracture with sharp edge associated with diaphragm injury // Clin Exp Emerg Med. 2018; 5(1):60-65 Doi:10.15441/ceem.16.190
12. Bozzay J.D., Bradley M.J. Management of post-traumatic retained hemothorax.// Trauma. 2019; 21:14e20. Doi: 10.1177/1460408617752985.
13. Rodriguez R.M., Canseco K., Baumann B.M., Mower W.R., Langdorf M.I., Medak A.J., Anglin D.R., Hendey G.W., Addo N., Nishijima D., Raja A.S. Pneumothorax and Hemothorax in the Era of Frequent Chest Computed Tomography for the Evaluation of Adult Patients With Blunt Trauma.// Journal Ann Emerg Med. 2018; 73(1):1-8. Doi: 10.1016/j.annemergmed.2018.08.423
14. Kim M., Moore J. E. Chest Trauma: Current Recommendations for Rib Fractures,Pneumothorax, and Other Injuries. // Current Anesthesiology Reports. 2020; 10:61–68. Doi: 10.1007/s40140-020-00374-w
15. Huang J.-F., Hsu C.-P., Fu C.-Y., Yang C.-H.O., Cheng C.-T., Liao C.-H., Kuo I-M., Hsieh C.-H. Is massive hemothorax still an absolute indication for operation in blunt trauma? // Injury. 2021; 52(2):225-230. Doi: 10.1016/j.injury.2020.12.016.
16. Зайцев Д.А., Мовчан К.Н., Лишенко И.В., Слободкина А.С., Кочетков А.В., Гедгафов Р.М., Русакевич К.И. Использование торакоскопии под местным обезболиванием и протеолитических ферментов в устранении свернувшегося гемоторакса. // Вестник Санкт-Петербургского университета. Медицина. 2018. 13(3): 271-281. Doi: 10.21638/11701/spbu11.2018.304
17. Zaitsev D.A., Movchan K.N., Lishenko I.V., Slobodkina A.S., Kochetkov A.V., Gedgafov R.M., Rusakevich K.I. The use of thoracoscopy under local anesthesia and proteolytic enzymes in the elimination of clotted hemothorax. Bulletin of St. Petersburg University. Medicine. 2018. 13( 3 ): 271-281. (In Russ.).
18. Doi: 10.21638/11701/spbu11.2018.304
19. Demetri L, Martinez Aguilar M.M., Bohnen J.D., Whitesell R., Yeh D.D., King, D. Is observation for traumatic hemothorax safe? // J Trauma Acute Care Surg. 2018; 84:454e458. Doi: 10.1097/ta.0000000000001793
20. Организация и оказание скорой медицинской помощи пострадавшим в дорожно-транспортных происшествиях: под редакцией чл.-корр. РАМН мроф. С.Ф.Багненко, проф. В.В.Стожарова, проф. А.Г.Мирошниченко. СПб, НИИСП им. Джанелидзе, 2011. – 400c.
21. Organization and provision of emergency medical care to victims of road traffic accidents: edited by Corr. RAMN prof. S.F. Bagnenko, prof. V.V. Stozharova, prof. A.G. Miroshnichenko. St. Petersburg, NIISP them. Dzhanelidze, 2011. - 400 p .
22. Тулупов А.Н., Синенченко Г.И. Торакоабдоминальная травма. СПб.: Фолиант, 2016. – 312с.
23. Tulupov A.N., Sinenchenko G.I. Thoracoabdominal trauma. St. Petersburg: Folio, 2016. - 312p.
24. Gonzalez G., Robert C., Petit L., Biais M., Carrié C. May the initial CT scan predict the occurrence of delayed hemothorax in blunt chest trauma patients? // Eur J Trauma Emerg Surg. 2021; 47(1):71-78. Doi: 10.1007/s00068-020-01391-4.
25. Купрюшин А.С., Ефимов А.А., Логинов С.Н., Вишнякова Ж.С.,Латынова И.В., Семина М.Н., Годухина Е.М. Клинические проявления и судебно-медицинская оценка гемоторакса // Саратовский научно-медицинский журнал. 2017. Т.13. №2, С.221-224 https://elibrary.ru/download/elibrary_30724061_36487710.pdf
26. Kupriushin A.S., Efimov A.A., Loginov S.N., Vishnyakova Zh.S., Latynova I.V., Semina M.N., Godukhina E.M. Clinical manifestations and forensic evaluation of hemothorax. Saratov Journal of Medical Scientific Research. 2017. 13 (2): 221-224 https://elibrary.ru/download/elibrary_30724061_36487710.pdf
27. Matsumoto S., Sekine K., Funabiki T., Yamazaki M., Orita T., Shimizu M., Hayashida K., Kishikawa M., Kitano M. Chest tube insertion direction: is it always necessary to insert a chest tube posteriorly in primary trauma care? // Am J Emerg Med. 2015; 33(1):88-91. Doi: 10.1016/j.ajem.2014.10.042.
28. Langdorf M.I., Medak A.J., Hendey G.W., Nishijima D.K., Mower W.R., Raja A.S., Baumann B.M., Anglin D.R., Anderson C.L., Lotfipour S. Prevalence and Clinical Import of Thoracic Injury Identified by Chest Computed Tomography but Not Chest Radiography in Blunt Trauma: Multicenter Prospective Cohort Study. // Ann Emerg Med. 2015; 66: 589-600 Doi: 10.1016/j.annemergmed.2015.06.003
29. Sritharen Y., Hernandez M.C., Haddad N.N., Kong V., Clarke D., Zielinski M.D., Aho J.M. External Validation of a Tube Thoracostomy Complication Classification System. // World J Surg. 2018; 42:736–41. Doi: 10.1007/s00268-017-4260-8
30. De Lesquen H., Avaro J.-P., Gust L., Ford R.M., Beranger F., Natale C., Bonnet P.-M., D'Journo X.-B. Surgical management for the first 48 h following blunt chest trauma: state of the art (excluding vascular injuries). // Interact Cardiovasc Thorac Surg. 2015; 20(3):399-408. Doi: 10.1093/icvts/ivu397.
31. Gilbert R.W., Fontebasso A.M., Park L., Tran A., Lampron J. The management of occult hemothorax in adults with thoracic trauma: A systematic review and meta-analysis. // J Trauma Acute Care Surg. 2020; 89(6):1225-1232. Doi: 10.1097/TA.0000000000002936
32. Choi J., Villarreal J., Andersen W., Min J.G., Touponse G., Wong C., Spain D.A., Forrester J.D. Scoping review of traumatic hemothorax: Evidence and knowledge gaps, from diagnosis to chest tube removal. // Surgery. 2021; 170(4):1260-1267. Doi: 10.1016/j.surg.2021.03.0.30
33. Быков В.П., Павлов К.О., Попов В.А., Коробицын А.П., Федосеев В.Ф., Собинин О.В. Хирургическое лечение повреждений и болезней легких у пациентов с закрытой травмой груди // Хирургия. Журнал им. Н.И. Пирогова. 2020. № 12. С. 64-69. Doi:10.17116/hirurgia202012164
34. Bykov VP, Pavlov KO, Popov VA, Korobitsyn AP, Fedoseev VF, Sobinin OV. Surgical treatment of lung injuries and diseases in patients with blunt chest trauma. Pirogov Russian Journal of Surgery 2020;(12):64 69. (In Russ.). Doi:10.17116/hirurgia202012164
Supplementary files
|
1. Неозаглавлен | |
Subject | ||
Type | Other | |
View
(470KB)
|
Indexing metadata ▾ |
![]() |
2. Сведения об авторах | |
Subject | ||
Type | Исследовательские инструменты | |
Download
(19KB)
|
Indexing metadata ▾ |
![]() |
3. Таблица | |
Subject | ||
Type | Исследовательские инструменты | |
Download
(15KB)
|
Indexing metadata ▾ |
Review
For citations:
Plaksin S.A., Ponomarev D.N., Sozkov A.J. Surgical management of hemothorax due to blunt chest trauma. Grekov's Bulletin of Surgery. 2023;182(3):40-46. (In Russ.)