Hemothorax Due to Transdiaphragmat-ic Liver Penetrating Injury Caused by Broken Knife

Thoracic trauma is one of the most fatal cases of patients admitted to emergency departments. Thoracic trauma occurs in 20–25% of all trauma patients worldwide and is the third cause of trauma-related deaths. Approximately 5% of trauma admissions are liver injuries. In some blunt or penetrating injuries, both intrathoracic and intra-abdominal organs may be injured. It is aimed to present the case of a broken knife entering from the right paravertebral location, causing hemothorax as a result of diaphragm and liver injury without injuring the lungs, due to the importance of the multidisciplinary approach among surgical departments in the study.

A 44-year-old male patient was admitted to the emergency department due to penetrating injury. An oblique injury of approximately 5 cm was seen in the posterior part of the right hemithorax. Radiologically, It was detected that the knife, which entered through the 10th intercostal space, was stuck inside and the knife handle was broken. It was observed that the broken blade entered from the paravertebral region, passed into the intrathoracic area, causing hemothorax, and passed from the edge of the inferior vena cava and embedded itself in the liver. Multidisciplinary operation planning was made among the departments. All department surgeons were present in the operating room at the same time. The paravertebral space was assessed and the embedded blade was slowly withdrawn by the neurosurgeon. Explorative laparotomy was done by the general surgeon and gastroenterology surgeon. Transdiaphragmatic injury was evaluated by the thoracic surgeon and major vascular structures were evaluated by the cardiovascular surgeon. In the postoperative period, the patient was discharged on the 5th postoperative day with full recovery without any complications.

Penetrating trauma is one of the most fatal cases of patients admitted to emergency departments. In some cases, intrathoracic and intra-abdominal penetrating injury may occur together, rarely from a single entrance location. The timing of critical intervention varies depending on whether the patient's vitals are stable or unstable. If the hemodynamics are stable in penetrating injuries, all affected anatomical structures should be evaluated with radiological examinations. For successful, uncomplicated surgical treatments, controlled techniques, interdepartmental consensus and, when necessary, simultaneous presence of surgeons in the surgery are essential