Document Detail


The spectrum of visceral injuries secondary to misplaced intercostal chest drains: Experience from a high volume trauma service in South Africa.
MedLine Citation:
PMID:  24974160     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
INTRODUCTION: Iatrogenic visceral injuries (IVI) secondary to the insertion of an intercostal chest drain (ICD) are well documented, but are usually confined to case reports and small series.
MATERIALS AND METHODS: We reviewed our experience with 53 consecutive patients over a insertion seven year period who sustained an IVI secondary to an ICD and describe the spectrum of injuries and clinical outcome in a high volume trauma service in South Africa.
RESULTS: A total of 53 ICDs were inserted in 53 patients, 83% (44/53) of which were on the left side, and 17% (9/53) on the right side. 92% (49/53) of the patients were males and the mean age for all patients was 24 (±8) years. 85% of the patients were referred from rural hospitals, the remaining 15% were treated initially at our institution. A trocar was used in 75% (40/53) of patients and in 9% (5/53), a trocar was not used, 58 organ injuries occurred in 53 patients. 92% (49/53) of patients sustained a single organ injury and 4 sustained multiple injuries. The three most common injuries were: diaphragm (36%, 21/53), gastric (22%, 13/53), and pulmonary (12%, 7/53). Other injuries were: 6 (10%) spleen, 4 (7%) liver, 2 (3%) colon and 1 (2%) kidney. Three (5%) sustained an injury to the intercostal artery and one (2%) sustained a pulmonary artery injury. 39 patients (74%) required operative interventions which included laparoscopy: 20 (51%), laparotomy: 8 (21%), thoracotomy: 8 (21%), VAT: 3 (8%). A total of 28 patients (53%) developed further complications: 13 wound sepsis, 7 pneumonia, 6 empyema, 2 ARDS. and 15% (8/53) required intensive care admission. The mean length of hospital stay was 7 (±4) days.
CONCLUSIONS: IVI is associated with significant morbidity, with diaphragmatic, gastric and pulmonary injuries being the most common. The majority were inserted in the rural hospitals and were associated with use of a trochar, Level of evidence: III, Study type: Retrospective study.
Authors:
Victor Y Kong; Damian L Clarke
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-5-21
Journal Detail:
Title:  Injury     Volume:  -     ISSN:  1879-0267     ISO Abbreviation:  Injury     Publication Date:  2014 May 
Date Detail:
Created Date:  2014-6-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0226040     Medline TA:  Injury     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 Elsevier Ltd. All rights reserved.
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