Penetrating gunshot wounds of the chest in civilian practice: Experience with 250 consecutive cases

Oparah, Sonny S.; Mandal, Ashis Kumar

doi:10.1002/bjs.1800650113

Cited by 35 publications

(14 citation statements)

References 21 publications

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“…The proportion of those who can be treated without operation has been reported to vary from 62.1% to 91.4% [2][3][4][5][6]13]. In our series, nonoperative treatment of penetrating chest injuries was successful in 92%.…”

Section: Discussionmentioning

confidence: 43%

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Penetrating Chest Injuries: Unusually High Incidence of High‐velocity Gunshot Wounds in Civilian Practice

et al. 1998

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Penetrating chest injuries are a challenge to the thoracic or trauma surgeon. Penetrating thoracic trauma, especially that due to high-velocity gunshot wounds, is increasing at an alarming rate in our region. We report our experience with penetrating chest injuries mainly due to high-velocity gunshot wounds. During a period of 6 years we retrospectively reviewed the hospital records of 755 patients admitted to the Department of Thoracic and Cardiovascular Surgery, Dicle University School of Medicine, with the diagnosis of penetrating thoracic trauma. The mean age was 27.48 years, and 89-8% were male. The causes of penetrating injury were stab wounds in 45.3% and gunshot wounds in 54.7%. About 30% of the wounds were due to high-velocity gunshots; and among the gunshot wounds 56.2% were due to high-velocity shots. The most common thoracic injury was hemothorax (n = 190) followed by hemopneumothorax (n = 184). Isolated thoracic injuries were found in 53% of the patients. Nonoperative management was sufficient in 92% of the patients. Thoracotomy was performed in 8.1%. The mean duration of hospitalization was 11.2 days. The mean injury severity score (ISS) was 20.17 +/- 13.87. The morbidity was 23.3% and the mortality 5.6%. Fifty percent of all deaths were due to adult respiratory distress syndrome. Altogether 17% of patients with an ISS > 25 died, whereas only 0.9% of those with a score < 16 died. The mortality due to firearms was 8.95%. We concluded that in civilian practice chest tube thoracostomy remains by far the most common method of treating penetrating injury to the chest. The easy availability of high-velocity guns will continue to increase the number of civilians injured by these weapons.

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Section: Discussionmentioning

confidence: 43%

“…Thoracic surgeons generally agree that most patients with penetrating wounds of the chest can be managed successfully without operation [2][3][4][5][6][11][12][13][14][15]. The proportion of those who can be treated without operation has been reported to vary from 62.1% to 91.4% [2][3][4][5][6]13].…”

Section: Discussionmentioning

confidence: 99%

Penetrating Chest Injuries: Unusually High Incidence of High‐velocity Gunshot Wounds in Civilian Practice

et al. 1998

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“…1,2,5,15,16,17 O fígado, ocupando área correspondente ao hemidiafragma direito e parte do esquerdo, foi a víscera abdominal mais atingida, com 63 (57,3%) pacientes, seguido pelo baço com 34 (30,9%), estômago 32 (29,1%), rim 19 (17,3%) e cólon com 16 (14,5%) casos.…”

Section: Discussionunclassified

“…1,2,3 Assim, nestes pacientes, não é rara a ocorrência de deiscência da sutura dos órgãos intra-abdominais atingidos, que leva ao aparecimento de fístulas digestivas, com graves repercussões hidreletrolíticas e nutricionais, responsáveis por elevadas taxas de morbidade e mortalidade. 4,5 As controvérsias quanto ao tratamento são compreensíveis, dadas as dificuldades, já referidas, relativas ao diagnóstico correto. Por outro lado, como duas cavidades são atingidas, muito se discute sobre a conduta quanto às prioridades e às vias de acesso cirúrgico, com intuito de reduzir as possíveis complicações que podem acometer estas cavidades.…”

Section: Introductionunclassified

Incidência de fístulas digestivas nos ferimentos toracoabdominais

Mantovani

Fontelles

Ajub

et al. 2000

Rev. Col. Bras. Cir.

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RESUMO:Os ferimentos penetrantes localizados na transição toracoabdominal (FTA), além da dificuldade diagnóstica, merecem especial atenção em relação à conduta adotada para o controle das complicações abdominais. Os autores analisaram 110 pacientes atendidos na Disciplina de Cirurgia do Trauma do Departamento de Cirurgia da UNICAMP, de 1988 a 1998, apresentando ferida penetrante toracoabdominal e submetidos à laparotomia exploradora com drenagem pleural fechada. As fístulas digestivas foram estudadas quanto à incidência, ao tratamento e à evolução pós-operatória. Do total de pacientes, 91 (82,7%) eram do sexo masculino e 19 (17,3%) do sexo feminino. A faixa etária situou-se entre 13 e 63 anos. Os FTA foram causados por projétil de arma de fogo (PAF) em 60 (54,5%) casos e por arma branca (FAB) em 50 (45,5%). As fístulas digestivas ocorreram em seis (5,4%) dos pacientes estudados, sendo quatro (3,6%) casos de fístula pancreática, um (0,9%) de fístula gástrica e um (0,9%) de fístula biliar, todos tratados de maneira conservadora, apresentando evolução favorável com resolução espontânea. INTRODUÇÃOEstudos conduzidos na área do trauma têm dirigido especial atenção às lesões penetrantes localizadas em topografia a mais variada, em especial, àquelas que acometem a transição toracoabdominal com comprometimento do músculo diafragma-torácico. Estas, apresentam características próprias, sobretudo no que se refere à dificuldade diagnóstica e ao tratamento adequado. As lesões de vísceras ocas que, freqüentemente, acompanham estes ferimentos, podem ocasionar contaminação da cavidade peritonial com possibilidade de estender-se ao espaço pleural. 1, 2, 3 Assim, nestes pacientes, não é rara a ocorrência de deiscência da sutura dos órgãos intra-abdominais atingidos, que leva ao aparecimento de fístulas digestivas, com graves repercussões hidreletrolíticas e nutricionais, responsáveis por elevadas taxas de morbidade e mortalidade. 4,5 As controvérsias quanto ao tratamento são compreensíveis, dadas as dificuldades, já referidas, relativas ao diagnóstico correto. Por outro lado, como duas cavidades são atingidas, muito se discute sobre a conduta quanto às prioridades e às vias de acesso cirúrgico, com intuito de reduzir as possíveis complicações que podem acometer estas cavidades.Tendo em vista estas dificuldades, foram revistos todos os casos de ferimentos toracoabdominais (FTA) ocorridos nos últimos dez anos, objetivando avaliar a incidên-cia, o tratamento e a evolução das fístulas digestivas que acometeram estes pacientes.

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“…For penetrating TDI, the most important indirect sign on CT scan is the presence of contiguous injuries to structures on both sides of the diaphragm, most commonly a hemothorax or lung injury coupled with a liver injury (rightside) or spleen/gastric injury (left side) [21•]. CT reconstruction of the missile tract for firearm injuries can also be helpful for assessing whether the trajectory is suspicious for traversing the diaphragm [13,27].…”

Section: Diagnosis/work-upmentioning

confidence: 99%

Penetrating Traumatic Diaphragm Injuries

DeBarros

Martin

2015

Curr Trauma Rep

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Traumatic diaphragm injuries (TDI) are uncommon but can result in major morbidity or mortality if missed. Penetrating thoracoabdominal injuries carry a high risk of TDI, but can also pose a diagnostic dilemma due to their small size and the frequent lack of an associated hernia. Despite advances in imaging, diagnosis without presence of a hernia remains difficult and a high index of suspicion must be maintained. Chest x-ray remains an important tool in early diagnosis, but primarily relies on the presence of a hernia or a discontinuity of the diaphragm, which is not typically seen with penetrating injuries. Computed tomography has a higher sensitivity and specificity and improves preoperative diagnosis, but most TDI are still diagnosed intra-operatively. Minimally invasive modalities allow for both diagnosis and repair of suspected injuries in hemodynamically stable patients while avoiding the morbidity of an open approach. All penetrating diaphragmatic injuries require repair in order to avoid the major morbidity and mortality of a chronic diaphragmatic hernia. The principles of diaphragmatic injury repair are complete reduction of all abdominal contents, lavage and evacuation of any associated hemothorax or gastrointestinal spillage, and watertight, tension-free closure. Most injuries can be closed primarily, but some may require use of prosthetic material or other advanced reconstructive techniques for larger defects. Mortality remains primarily dependent on the mechanism of injury and the presence and severity of associated injuries, with overall Injury Severity Score serving as an independent predictor of early mortality.

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Penetrating gunshot wounds of the chest in civilian practice: Experience with 250 consecutive cases

Cited by 35 publications

References 21 publications

Penetrating Chest Injuries: Unusually High Incidence of High‐velocity Gunshot Wounds in Civilian Practice

Penetrating Chest Injuries: Unusually High Incidence of High‐velocity Gunshot Wounds in Civilian Practice

Incidência de fístulas digestivas nos ferimentos toracoabdominais

Penetrating Traumatic Diaphragm Injuries

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