Journal of Trauma and Injury

  • 제28권2호
  • /
  • Pages.79-82
  • /
  • 2015
  • /
  • 2799-4317(pISSN)
  • /
  • 2287-1683(eISSN)
대한외상학회 (The Korean Society of Traumatology)
권호 표지

하부늑골 골절에 의한 지연성 대량혈흉을 동반한 횡격막 손상

Delayed Diaphragmatic Injury with Massive Hemothorax Due to Lower Rib Fracture

  • 김우식 (국립중앙의료원 흉부외과) ;
  • 김중석 (국립중앙의료원 외상외과)
  • Kim, Woo-Shik (Department of Thoracic and Cardiovascular Surgery, National Medical Center) ;
  • Kim, Joong-Suck (Department of Trauma Surgery, National Medical Center)
  • 투고 : 2015.02.14
  • 심사 : 2015.05.15
  • 발행 : 2015.06.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Simple rib fracture is one of most common injury after blunt thoracic trauma found in approximately 7% to 40% of cases. Delayed traumatic diaphragmatic injury with massive hemothorax after rib fracture is rare but a potentially life-threatening condition. We present a rare case of a 79-year-old male with delayed diaphragmatic injury with massive hemothorax due to fracture of the lower ribs. Under thoracoscopy, hemothorax was evacuated, diaphragmatic rupture was identified and repaired, and the lower ribs were fixed with metal plate (s). Although simple lower rib fractures may be the only clinical finding, close observation and monitoring are required because of the possibility of diaphragmatic and/or intraabdominal organ injury.

키워드

참고문헌

  1. Gabram SG, Schwartz RJ, Jacobs LM, et al. Clinical management of blunt trauma patients with unilateral rib fractures: a randomized trial. World J Surg 1995; 19: 388-93. https://doi.org/10.1007/BF00299166
  2. Seongsik Park, M.D. Clinical Analysis for the Correlation of Intra-abdominal Organ Injury in the Patients with Rib Fracture Korean J Thorac Cardiovasc Surg 2012; 45: 246-50 https://doi.org/10.5090/kjtcs.2012.45.4.246
  3. Tsai FC, Chang YS, Lin PJ, Chang CH. Blunt trauma with flail chest and penetrating aortic injury. Eur J Cardiothorac Surg 1999; 16: 374-7. https://doi.org/10.1016/S1010-7940(99)00230-4
  4. Misthos P, Kakaris S, Sepsas E, et al. A prospective analysis of occult pneumothorax, delayed pneumothorax and delayed hemothorax after minor blunt thoracic trauma. Eur J Cardiothorac Surg 2004; 25: 859-64. https://doi.org/10.1016/j.ejcts.2004.01.044
  5. Sharma OP, Hagler S, Oswanski MF. Prevalence of delayed hemothorax in blunt thoracic trauma. Am Surg 2005; 71: 481-6.
  6. Desir A, Ghaye B. CT of blunt diaphragmatic rupture. Radiographics 2012; 32: 477-98. https://doi.org/10.1148/rg.322115082
  7. George L, Rehman SU, Khan FA. Diaphragmatic rupture: a complication of violent cough. Chest 2000; 117: 1200-1. https://doi.org/10.1378/chest.117.4.1200
  8. Bocchini G, Guida F, Sica G, et al. Diaphragmatic injuries after blunt trauma: are they still a challenge? Reviewing CT findings and integrated imaging. Emerg Radiol 2012; 19: 225-35. https://doi.org/10.1007/s10140-012-1025-4
  9. Yetkin G, Uludag M, Citgez B. Traumatic diaphragmatic hernia resulting in intestinal obstruction. BMJ Case Rep 2009;pii: bcr06. 2008. 0258.
  10. Zarzavadjian Le Bian A, Costi R, Smadja C. Delayed rightsided diaphragmatic rupture and laparoscopic repair with mesh fixation. Ann Thorac Cardiovasc Surg 2013. (in press)
  11. Alon Ben-Nun, MD, PhD, Michael Orlovsky, MD, and Lael Anson Best, MD. Video-assisted thoracoscopic surgery in the treatment of chest trauma: Long-term benefit Ann Thorac Surg 2007; 83: 383-7. https://doi.org/10.1016/j.athoracsur.2006.09.082
  12. Goodman M, Lewis J, Guitron J, et al. Video-assisted thoracoscopic surgery for acute thoracic trauma. J Emerg Trauma Shock 2013; 6: 106-9. https://doi.org/10.4103/0974-2700.110757