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Fri, 29 Mar 2002 11:16:02 -0300

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    The patient was sent to the OR and we placed a Right chest tube  ( =
initial output =3D 2000ml ) .We made a Right thoracotomy that revealed   =
a  transfixing heart wound ( caval - 1cm - and right atrium - 3 cm - =
laceration ), a large right hemothorax and a pulmonary laceration. There =
was no esophageal injury . We repaired all the wounds quickly and we =
made a midline laparotomy before the thoracotomy closure. We found a =
tranxfixig jejunal and left colon wound and a ureteral complete section =
with no significant hemorrhage.  We closed  the intestinal wouns =
primarily and made a ureteroureterostomy over an internal stent, after =
spatulation .
    After the abdominal closure, we returned to the thorax in order to =
close it but at that time the patient blood pressure decreased and we =
saw a considerable amount of bright red arterial blood coming from the =
LEFT hemithorax ( the pleura was opened in the mediastinum during the =
esophageal dissection )....
   WHAT WOULD YOU DO?

   =20
    Marcos Reis,  MD        Trauma Surgeon
    Jo=E3o XXII Hospital - Trauma Center - Belo Horizonte, Brazil =20

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<DIV><FONT face=3DArial size=3D2>&nbsp;&nbsp;&nbsp; The patient was sent =
to the OR=20
and we placed a Right chest tube&nbsp; ( initial output =3D 2000ml ) .We =
made a=20
Right thoracotomy that revealed&nbsp;&nbsp; a&nbsp; transfixing heart =
wound (=20
caval - 1cm - and right atrium - 3 cm - laceration ), a large right =
hemothorax=20
and a pulmonary laceration. There was no esophageal injury . We repaired =
all the=20
wounds quickly and we made a midline laparotomy before the thoracotomy =
closure.=20
We found a tranxfixig jejunal and left colon wound and a ureteral =
complete=20
section with no significant hemorrhage.&nbsp; We closed  the intestinal =
wouns=20
primarily and made a ureteroureterostomy over an internal stent, after=20
spatulation .</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>&nbsp;&nbsp;&nbsp; After the abdominal =
closure, we=20
returned to the thorax in order to close it but at that time the patient =
blood=20
pressure decreased and we saw a considerable amount of bright red =
arterial blood=20
coming from the LEFT hemithorax ( the pleura was opened in the =
mediastinum=20
during the esophageal dissection )....</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>&nbsp;&nbsp;&nbsp;WHAT WOULD YOU =
DO?</FONT></DIV>
<DIV>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2>&nbsp;&nbsp;&nbsp;=20
<DIV><FONT face=3DArial size=3D2>&nbsp;&nbsp;&nbsp; Marcos Reis,&nbsp;=20
MD&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp; Trauma Surgeon</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>&nbsp;&nbsp; &nbsp;Jo=E3o XXII Hospital =
- Trauma=20
Center - Belo Horizonte, Brazil&nbsp; =
</FONT></DIV></FONT></DIV></BODY></HTML>

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