Yang Xian-Wei, Wang Wen-Tao
Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610000, Sichuan Province, China.
World J Clin Cases. 2020 Oct 26;8(20):5025-5029. doi: 10.12998/wjcc.v8.i20.5025.
Combined penetrating trauma involving the chest, pericardium, abdomen, and thigh is rare and lethal. It is difficult to quickly rescue patients with penetrating injuries from long steel bars.
A previously healthy 56-year-old male worker presented with a length of rebar that penetrated the chest-abdomen-pelvic cavity and was palpable on the anterior side of the neck and thigh. On radiological imaging, the left chest wall-left chest cavity-mediastinum-abdominal cavity-right groin area-right thigh demonstrated a strip-like density shadow, about 1.5 cm thick, with the heart, stomach wall, and part of the intestine involved. There was a left-sided pleural effusion, left lung compression of about 50%-60%, and a small amount of left pleural effusion/blood accumulation; possible perforation of hollow organs; and double multiple ribs fractures on the side. An emergency green channel was opened to provide a rescue process for smooth and timely diagnostic and treatment to save the patient's life. The patient was followed at 4 mo after discharge and showed good recovery.
For pre-hospital emergency treatment in locations that are not fully prepared for surgery, we do not recommend cutting the steel bars outside the body. We advocate pulling out foreign bodies intact to reduce secondary injuries.
胸部、心包、腹部和大腿联合穿透伤罕见且致命。对于被长钢筋穿透伤的患者,很难进行快速救治。
一名56岁既往健康的男性工人,一根钢筋贯穿胸-腹-盆腔,在颈部前方和大腿可触及。影像学检查显示,左胸壁-左胸腔-纵隔-腹腔-右腹股沟区-右大腿呈条索状密度影,约1.5厘米厚,累及心脏、胃壁和部分肠管。存在左侧胸腔积液,左肺压缩约50%-60%,少量左侧胸腔积液/积血;存在中空器官可能穿孔;同侧多发肋骨双骨折。开通急诊绿色通道,为患者提供顺畅、及时的诊断和治疗抢救过程以挽救生命。患者出院后4个月随访,恢复良好。
对于未充分做好手术准备的现场院前急救,不建议在体外切断钢筋。主张完整拔出异物以减少二次损伤。