Transdiaphragmatic pleural lavage in penetrating thoracoabdominal trauma

Background: The purpose of this study was to determine the incidence of thoracic sepsis following a systematic thoracic cavity washout through the injured diaphragm in patients with penetrating thoracoabdominal trauma. Methods: Prospectively collected data on all patients presenting with penetrating...

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Bibliographic Details
Published in:British journal of surgery 2004-12, Vol.91 (12), p.1619-1623
Main Authors: Zellweger, R., Navsaria, P. H., Hess, F., Omoshoro-Jones, J., Kahn, D., Nicol, A.
Format: Article
Language:English
Subjects:
Abdominal Injuries - surgery
Adolescent
Adult
Biological and medical sciences
Diaphragm
Female
General aspects
Humans
Male
Medical sciences
Middle Aged
Postoperative Complications - etiology
Prospective Studies
Sepsis - etiology
Therapeutic Irrigation - methods
Thoracic Injuries - surgery
Trauma Severity Indices
Wounds, Penetrating - surgery
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Summary:Background: The purpose of this study was to determine the incidence of thoracic sepsis following a systematic thoracic cavity washout through the injured diaphragm in patients with penetrating thoracoabdominal trauma. Methods: Prospectively collected data on all patients presenting with penetrating thoracoabdominal trauma between July 1999 and July 2002 were analysed. Patients with peritoneal biliary–gastroenteric (BGE) contamination and a diaphragmatic laceration were managed by laparotomy and transdiaphragmatic thoracic lavage. Results: A total of 217 patients had penetrating thoracoabdominal injuries, of whom 110 had BGE contamination of the peritoneal cavity with spillage into the pleural cavity. The mean Injury Severity Score was 38·1. Gunshot and stab wounds occurred in 79 (71·8 per cent) and 31 (28·2 per cent) respectively. Contamination was from the stomach (55·4 per cent), large bowel (37·3 per cent), small bowel (29·1 per cent), gallbladder and bile ducts (9·1 per cent) and pancreas (6·4 per cent). Thoracic complications occurred in six patients (5·5 per cent): empyema in two, Escherichia coli‐related pneumonia in three and pleuritis in one. There were no deaths. Conclusion: A thoracic washout through the injured diaphragm in patients with penetrating thoracoabdominal trauma and BGE contamination was associated with a low rate of intrathoracic septic complications. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Washout through diaphragm is OK
ISSN:0007-1323
1365-2168
DOI:10.1002/bjs.4598