HEMOTHORAX FOLLOWING PENETRATING THORACIC INJURY (GUNSHOT WOUND) IN GERIATRIC PATIENT: A CASE REPORT AND EMERGENCY MANAGEMENT

Gerardo AK Laksono, Ferdinand Erwin, Dyana Sarvasti, Paul L Tahalele

Abstract


Introduction: Penetrating chest trauma is highly lethal. Studies have reported up to 60%
mortality depending on the mechanism of injury. While penetrating chest trauma is less
common than blunt trauma, it can be more deadly. High-velocity gunshot injury resulting in
penetrating thoracic trauma in geriatric patients poses a significant challenge for the traumatic
surgeon. Hemothorax is usually a consequence of penetrating chest trauma. It can be caused by
intercostal arterial bleeding, especially the posterior part. Initial treatment, including chest tube
drainage insertion, is needed to avoid lung compression and to assess future treatment needed.
Purpose: To report the patient survival from massive hemothorax caused by penetrating
Thoracic injury caused by an air rifle, treated by chest tube insertion and posterolateral
thoracotomy to take out the bullet several days after.
Case Report: 70-year male patient came to the Emergency Room (ER) Adihusada Hospital
Surabaya with a penetrating chest injury caused by an air rifle on the right side of the chest.
The patient had chest pain, shortness of breath, and hypoxia. By inserting a chest tube,
emergency management was done by a general surgeon due to the massive right hemothorax.
An immediate chest tube insertion was needed to overcome the patient’s breathing problem to
assess the future treatment needed. Chest X-ray and CT-Scan was done immediately after the
patient’s hemodynamic were stable. Three days after hospitalizing, the Cardiothoracic and
vascular surgeon performed posterolateral thoracotomy to take the bullet out of the chest.
Conclusion: Seven days postoperatively, the patient was discharged from the hospital without
any complications and stable hemodynamic. The patient went to the outpatient department for
follow-up one week after.


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Keywords


Chest injury; penetrating chest injury; gunshot injury; hemothorax

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References


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DOI: https://doi.org/10.33508/jwmj.v3i2.3180

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