Presentation : Stab injury to left chest – 24hrs
Patient was allegedly attacked by armed robbers who stabbed him. He was found and sent to the nearest hospital by passersby . The referring hospital initially attempted to remove the knife from his chest but it got broken leading to the sharp tip laying buried deep in the chest. The patient was quickly referred to KATH.
Examination :
blood pressure 120/8ommhg, pulse 76bpm, RR 25cpm. Temp 36.5 deg, GCS 15/15 mild flaring of alae nasae
Chest :
Air entry adequate at lung apices and middle zones but slightly reduced over left lower zone ,trachea was central , tenderness over left hemithorax , no subcutaneous emphysema, 4cm wound in the 4th intercostal space left mid axillary line covered with sterile dressing
Abdominal moved with respiration, soft, not distended
No neurological deficit detected extremities were normal.
Diagnosis :
Penetrating chest injury
Investigations
HB 11.1, WBC 4* 10 , Plt 256, blood group O positive electrolytes normal.
CXR : Piece of broken knife buried lying deep in the left hemithorax, posteriorly located with the sharp end pointing cephalad. No evidennce of haemopneumothorax seen. No evidence of rib fracture.
A decison was taken to perform a thoracotomy to remove the foreign body .
Anesthesia :
General anaesthesia with cuffed ET tube
Operative details :
a left anterolateral thoracotomy through 4th intercostal space. Muscles of the anterolateral chest wall divided . Parietal pleura opened and ribs retracted . Left lung collapsed to aid retraction. The knife piece was found posterio- superiorly on abutting the visceral pleura of the left superior lung segemnts. Long curved artery was used to extract the knife. Pleural cavity was lavaged with normal saline and drained with under water seal drainage tube. Muscles were apposed with interupted vicryl 0 sutures. Left lung re-inflated. skin was apposed with nylon 0 interrupted sutures. Plain marcaine 0.25% was used to infiltrate the subcutaneous tissues. Patient was sent to ICU for monitoring
24 hrs post op his temperature rose to 39deg. This subsequently settled with antipyretics and antibiotics( meronem 1g tds * 3) . Patient later put on oral cefuroxime 5oomg bd for 7 days
Patient made remarkable recovery . Check chest x -rays showed satisfactory lung expansion.
Surgeon : Dr V. Ativor (Trauma/ Orthopaedic surgeon )
Assistant 1 : Dr R Ametih
Assistant 2 : Dr. Gyimah
