Distinctive features of a gun shot thoracoabdominal injury in tangentialwounding

Abstract

Introduction: Thoracoabdominal injuries are the most serious injuries at the war or peace time, representing one of the most difficult problems of emergency surgery. Difficulty of the diagnosis, a significant number of tactical and diagnostic errors and complications in health care characterize them. The so-called tangential wounds are when there is a large destruction of bone structures, and internal organs, notwithstanding the fact that the wound channel extends longitudinally in the soft tissue of the chest and abdominal wall without damage to the diaphragm due to the high kinetic energy of the wounding element. They occur gunshot thoracoabdominal wounding. Materials and methods: The analysis of 49 clinical cases of injuries in the area of anti-terrorist operation in eastern Ukraine, who were treated at the Military-medical clinical center of the central region. The diagnosis of thoracoabdominal injury was confirmed radiographically and intraoperatively. Discussion results: All analyzed injuries related to severe group. The shape of the wound channel was observed: through injury in 20 (48.8%), blind in 24 (49%) and tangential in 5 (10.2%) patients. In all cases the tangential wounds in the chest and abdomen were deep linear wounds. There was not a violation of the integrity of the parietal pleura and peritoneum therefore, these injuries were non-penetrating. The inlet of the wound channel in 21 (42.8%) case was in the abdominal wall (abdominothoracal injured). Depending on the dominant pathological process in injuries surgery began with the chest in 4 (8.1%) or abdominal cavity in 45 (91.9%) cases. Injuries of abdominal organs was observed in all the wounded with thoracoabdominal trauma, including isolated damage, found in 15 (30.6%), combined - in 34 cases, the damage to two organs of the abdominal cavity in 23 (46.9%) patients, three - in 9 (18.4%), four - in 2 (4.1%). Complications in thoracoabdominal wounds were in 34% of cases, which is twice greater than when isolated thoracic injuries had been observed. The mortality rate during thoracoabdominal injuries was 16.3%, whereas in isolated injuries it was about 5%. Conclusion: Thoracoabdominal injuries are serious injuries with high morbidity and mortality. A special place in the structure of thoracoabdominal trauma occupies tangential wounds, which despite the fact that they are non-invasive require a rapid diagnosis and an active surgical tactics.