EC Orthopaedics

Introduction: The complex thoraco-abdominal trauma is rare but life threating and very difficult to be managed. It is associated to a high morbidity and mortality. The goal of this study is to describe the diagnostic aspects and the management of the complications associated to this trauma.

Material and Methods: We will report the case of a hepatic pseudo aneurysm in a patient with the thoracic trauma and the rupture of the right diaphragm complicated with massive trans-thoracic hemorrhage.

Case Report: A 44 years old male, the patient was introduced to the ER after being hit by a heavy object. The CT evaluation revealed fractures of the 5-6-7-8-9-10^-th ribs with hemopneumothorax and central hepatic contusion. The first treatment: drainage of the right pleural space broad spectrum parenteral, antibiotic therapy perfusions and follow up of the patient. The day after the pleural drain has been removed, we noticed biliary effusion coming out from the drainage hole. A new CT evaluation 7 days after the first one confirmed the presence of multilocular fluid collections in the right pleural space, the rupture of the right diaphragm and contusion of the 7-8 hepatic segments.10 days after trauma was performed the right thoracotomy and both organised hemothorax and biliary empyema was evacuated and the diaphragm was suturated.16 days after trauma the patient developed hemobilia because of a fissuration of a pseudo aneurism in the central hepatic biliary way. The treatment for it was the administration of the kher drainage + cholecystectomy. After many episodes of hemorrhage associated to the hepatic pseudo aneurism and because we could not perform the hepatic artery embolization. The staff decided to perform the ligature of the right branch of the hepatic artery 4 weeks after trauma. The patient left hospital healthy 40 days after trauma.

Conclusion: The thoraco-abdominal complex trauma needs a multidisciplinary follow up. A very well-trained trauma staff and the disponibility of all medical equipments. Beside accurate management this trauma still has a high morbidity and mortality.

 Keywords: Ligature; Hepatic Artery; Massive Trans Thoracic Hemorrhage

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