Penetrating thoracoabdominal injuries

Abstract

Abstract Twenty-three cases of penetrating thoracoabdominal injury are reviewed. Abdominal pain, tenderness and rigidity were found to be the most constant indicators of diaphragmatic penetration in these injuries (65 per cent). These features may occur as referred phenomena of purely thoracic injuries and persist as a result of the presence of an intercostal drainage tube used in the treatment of such injuries. There may be no abdominal signs in injuries of the diaphragm unaccompanied by any visceral damage or in injuries confined to the lesser sac. A high index of suspicion in the presence of a wound over the lower half of the chest is necessary to detect these lesions. Negative radiological findings do not exclude a diaphragmatic injury. The thoracic component of a penetrating thoracoabdominal injury can usually be treated conservatively by aspiration or drainage of the pleural space, but laparotomy is advised for the repair of the abdominal viscera. The need for thoracotomy should be determined by the merits of the thoracic injury or the desirability of pleural toilet. The intra-abdominal injury may then be dealt with through the diaphragm. There is a greater tendency to pleural infection in thoracoabdominal injuries than in simple penetrating thoracic injuries, which is attributable to contamination by intestinal contents through the diaphragmatic tear. The mortality in this series was due to the abdominal injuries, the early recognition and treatment of which would have improved results.