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Case reports

Successful emergency resuscitative thoracotomy and thoracoscopy in an injured patient with impending death

^a Department of Surgery, Lillehammer Hospital, Lillehammer, Norway
^b Scandinavian Cardiovascular Surgery Center, Gothenburg, Sweden

Received 10 January 2008; received in revised form 4 March 2008; accepted 8 March 2008.

^_* Corresponding author. Address: Scandinavian Cardiovascular Surgery Center, Gothenburg or Hagforsgatan 71, 416 75 Gothenburg, Sweden. Tel.: +46 31 256 985/46 708 350 680; fax: +46 31 899072. (Email: mohebrashid{at}yahoo.se).

A 23-year-old man was bilaterally stabbed with knife creating 10 cm wide wounds similar to minithoracotomy incisions. Initially, the patient had no cardiac or respiratory activity. Emergency resuscitative thoracotomy was hastily performed on the right side. An Immediate manual occlusion of the pulmonary hilum was done as damage control. A pneumonorrhaphy was performed and the bleeding was completely stopped. The patient was stabilized and to avoid another thoracotomy on the left side due to massive blood loss, video-assisted thoracoscopic surgery (VATS) was performed. The wound was explored, the hemothorax was evacuated, and a superficial non-bleeding parenchymal pulmonary laceration was discovered. The postoperative course was uneventful and the patient was discharged home 10 days later, and returned to his physically demanding work after 5 weeks. It is concluded that VATS can be cautiously performed on the less severely injured side in patients with bilateral thoracic penetrating trauma in extremis following successful emergency resuscitative thoracotomy.

Key Words: Emergency surgery • Resuscitation • Thoracotomy • Thoracoscopy/VATS • Lung