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Ferreira-Pozzi M, Erramouspe PJ, Folonier JC, Perez MP, González DG, Laurin EG. Anterior Lung Evisceration Following an Assault with Knife: A Case Report. Clin Pract Cases Emerg Med 2021; 5:335-340. [PMID: 34437042 PMCID: PMC8373191 DOI: 10.5811/cpcem.2021.4.51603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/14/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction Evisceration of the lung is a rare consequence of open chest trauma that can be fatal. Evisceration of the lung refers to the protrusion of lung parenchyma through a defect of the thoracic wall, without parietal pleural or skin coverage. Case report A 20-year-old man was brought to the emergency department (ED) with left lung evisceration from stab wounds. The eviscerated lung was left in place, and the patient was not intubated in the ED. He was immediately taken to the operating room (OR) for intubation and surgical repair. Other significant injuries were ruled out, the eviscerated lung was retrieved, the chest wall defect was closed, and the patient recovered well. He was discharged after seven days in good condition. Conclusion The initial management of patients with lung evisceration is critical to prevent rapid decompensation and death. Appropriate ED airway management, lung retrieval in the OR, and thoracic wall repair is recommended for patients with lung evisceration.
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Affiliation(s)
- Martín Ferreira-Pozzi
- University of the Republic, Maciel hospital, Department of Surgery, Clínica quirúrgica 3, Montevideo, Uruguay
| | - Pablo Joaquin Erramouspe
- Queensland University of Technology, Translational Research Institute, Brisbane, Queensland, Australia.,University of California Davis Health, Department of Emergency Medicine, Sacramento, California
| | - Juan Carlos Folonier
- University of the Republic, Maciel hospital, Department of Surgery, Clínica quirúrgica 3, Montevideo, Uruguay
| | - Mauro Perdomo Perez
- University of the Republic, Maciel hospital, Department of Surgery, Clínica quirúrgica 3, Montevideo, Uruguay
| | - Daniel González González
- University of the Republic, Maciel hospital, Department of Surgery, Clínica quirúrgica 3, Montevideo, Uruguay
| | - Erik G Laurin
- University of California Davis Health, Department of Emergency Medicine, Sacramento, California
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2
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Pérez Castro P, Undurraga Machicao F, Santolaya Cohen R, Berrios Silva R, Rivera F. Minimally invasive management of traumatic lung herniation. J Surg Case Rep 2017; 2017:rjx130. [PMID: 28852454 PMCID: PMC5569919 DOI: 10.1093/jscr/rjx130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/06/2017] [Accepted: 06/19/2017] [Indexed: 11/18/2022] Open
Abstract
Post-traumatic pulmonary hernia can occur immediately after thoracic trauma or it may also appear months or even years after the onset. We report a case of a seventeen year-old male patient with thoracic blunt trauma secondary to high energy bicycle accident. Chest CT shows moderate hemothorax and pneumothorax, displaced fracture of the fifth left rib, and protusion of pulmonary tissue through a chest wall defect. In the Emergency Room the patient presents with chest pain (7/10 in Visual Analog Scale) and respiratory distress. Video-assisted thoracic surgery approach was chosen. Hernia reduction, non-anatomic lingular resection and rib fracture external fixation using a titanium plate was performed. Traumatic pulmonary hernia is an uncommon complication of thoracic trauma which may constitute an emergency for the trauma or thoracic surgeon. The early management of this injury can be developed by minimally invasive approach with excellent results.
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Affiliation(s)
- Pablo Pérez Castro
- Departament of Surgery, Universidad de Chile, Santiago, Chile.,Division of Thoracic Surgery, Toronto General Hospital, University of Toronto,Toronto, Canada
| | - Felipe Undurraga Machicao
- Departament of Surgery, Universidad de Chile, Santiago, Chile.,Department of Surgery, Clinica Las Condes, Santiago, Chile
| | - Raimundo Santolaya Cohen
- Departament of Surgery, Universidad de Chile, Santiago, Chile.,Department of Surgery, Clínica Alemana,Universidad del Desarrollo, Santiago, Chile
| | - Raul Berrios Silva
- Department of Surgery, Clínica Alemana,Universidad del Desarrollo, Santiago, Chile
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3
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Abu Tair A, Kull C, Rosenberg R, Mechera R. Lateral lung hernia following a low-energy trauma without bony injuries: A case report. Int J Surg Case Rep 2016; 24:54-6. [PMID: 27180321 PMCID: PMC4872471 DOI: 10.1016/j.ijscr.2016.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 04/18/2016] [Accepted: 05/02/2016] [Indexed: 12/03/2022] Open
Abstract
Lateral lung hernias are rare and can also occur following low-energy traumas. For thoracic pain with appropriate history and external signs of a trauma a CT scan should be considered at an early stage. Surgical management is recommended for persistent symptoms and large defect size.
Introduction Lateral lung hernias are rare, and a herniation of the lung is only reported in the context of high-energy trauma. The predilection site for lung hernias is the anterior thorax. Presentation of case We present the case of a 82-year-old male, who was admitted with dry cough, shortness of breath and breath-dependent left-sided chest pain after a fall. Chest X-ray suggested a pneumonia and subsequently the patient was treated with antibiotics. Due to persistent symptoms after 12 days a CT-scan was performed which showed an intercostal lung herniation without fractures. Surgeons were consulted and recommended an operative intervention. Intraoperatively the herniation could be confirmed and necrotic lung tissue was resected. The patient recovered well and was discharged after 10 days in good general condition. Discussion Herniation of lung tissue occurs as a result of injured intercostal muscles in a sudden increase of intrathoracic pressure. Especially lateral herniation is rare because of the additional lateral reinforcement of the thoracic wall by the Serratus muscle. While a conservative approach is possible in asymptomatic hernias and small defect size, surgical intervention is indicated for larger hernias, possible incarceration of lung tissue with resulting infarction and symptoms like chronic pain or respiratory failure. Conclusion For an adequate differential diagnosis of thoracic pain with a history and external signs of a trauma, a CT imaging should be evaluated at an early stage even after a low-energy trauma. An operation is indicated for large defect size and persistent symptoms.
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Affiliation(s)
- Assim Abu Tair
- Department of Surgery, Cantonal Hospital of Liestal, Rheinstrasse 26, 4410 Liestal, Switzerland.
| | - Christof Kull
- Department of Surgery, Cantonal Hospital of Liestal, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Robert Rosenberg
- Department of Surgery, Cantonal Hospital of Liestal, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Robert Mechera
- Department of Surgery, Cantonal Hospital of Liestal, Rheinstrasse 26, 4410 Liestal, Switzerland; Department of Surgery, University Hospital of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
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4
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A new technique of pulmonary hernia surgical repair using intramedullary titanium implants. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 12:26-9. [PMID: 26336474 PMCID: PMC4520499 DOI: 10.5114/kitp.2015.50564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 12/01/2014] [Accepted: 02/11/2015] [Indexed: 11/17/2022]
Abstract
Introduction In this paper we present a new method of pulmonary hernia surgical treatment. Pulmonary hernia is a rare pathology. The first description of pulmonary hernia was made by Roland in 1499. The world literature describes only a little more than 300 cases of pulmonary hernia. Pulmonary hernia is defined as the projection of the lung tissue covered by the parietal pleura beyond the normal boundaries of the pleural cavity, through the pathological holes in the chest wall. During our work as thoracic surgeons, we have used different ways of thoracic chest wall reconstructive operations and anastomoses of the broken ribs. Aim of the study To search for optimal methods of pulmonary hernia surgery and to evaluate a new technique of pulmonary hernia surgical repair using intramedullary titanium implants. Material and methods In 2013 in our clinic, we diagnosed and cured two patients with idiopathic pulmonary hernia. We performed a reconstructive operation of the chest wall with anastomosis of the broken ribs using titanium intramedullary stabilization implants – splints. Results To date, the annual observation has revealed no recurrence of pulmonary hernia or postoperative complications. At present, the patients demonstrate full life activity. Conclusions So far, in the world literature, we have not encountered any information about using such methods to repair pulmonary hernia. We regard our method as safe, easy to use and giving good therapeutic results.
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Bikhchandani J, Balters MW, Sugimoto JT. Conservative management of traumatic lung hernia. Ann Thorac Surg 2012; 93:992-4. [PMID: 22364998 DOI: 10.1016/j.athoracsur.2011.08.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 07/05/2011] [Accepted: 08/09/2011] [Indexed: 11/26/2022]
Abstract
Traumatic lung hernia is a rare entity. The majority of cases reported in the literature have been treated surgically with early thoracotomy to prevent strangulation of pulmonary tissue. We report the case of a 63-year-old patient who experienced a 20-foot fall, causing multiple rib fractures with a lung hernia that was managed conservatively for 48 hours followed by spontaneous resolution of the herniated pulmonary segment. There is a need to review the indications for surgical versus conservative approach in the management of posttraumatic lung hernia.
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Affiliation(s)
- Jai Bikhchandani
- Department of Thoracic Surgery, Creighton University Medical Center, Omaha, Nebraska 68154, USA.
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6
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Hebra A, Cina R, Streck C. Video-assisted thoracoscopic repair of a lung hernia in a child. J Laparoendosc Adv Surg Tech A 2011; 21:763-5. [PMID: 21745099 DOI: 10.1089/lap.2011.0147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pulmonary intercostal hernias are extremely rare. They have been reported to occur in children after blunt trauma to the chest wall as a result of disruption of intercostal muscle fibers. We present a case of a left anterior chest lung hernia caused by blunt handlebar chest trauma in a 13-year-old boy treated with placement of a mesh using a video-assisted thoracoscopic approach.
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Affiliation(s)
- André Hebra
- Division of Pediatric Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
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Marsico GA, Boasquevisque CHR, Loureiro GL, Marques RF, Clemente AM. [Traumatic lung hernia]. Rev Col Bras Cir 2011; 38:77-8. [PMID: 21537748 DOI: 10.1590/s0100-69912011000100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2006] [Accepted: 02/10/2007] [Indexed: 11/21/2022] Open
Abstract
Traumatic lung herniation is an unusual clinical problem. We present a case of a large left post-traumatic lung hernia on the left, anterior, second intercostal space following blunt chest trauma. An important factor in the etiology of these lesions is the relative lack of muscular support of the anterior part of the chest. This report describes the diagnosis and management of a post-traumatic lung hernia.
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Wiens S, Hunt I, Mahood J, Valji A, Stewart K, Bédard EL. Novel Fixation Technique for the Surgical Repair of Lung Hernias. Ann Thorac Surg 2009; 88:1034-5. [DOI: 10.1016/j.athoracsur.2008.12.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 11/30/2008] [Accepted: 12/02/2008] [Indexed: 10/20/2022]
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9
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An unusual case of a strangulated lung hernia after an Ivor Lewis esophagectomy. J Thorac Cardiovasc Surg 2009; 138:495-6. [DOI: 10.1016/j.jtcvs.2008.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2008] [Accepted: 04/13/2008] [Indexed: 10/21/2022]
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10
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Benckert C, Thelen A, Pfitzmann R, Gebauer B, Spinelli A, Jonas S, Neuhaus P. Harm from seat belt: transthoracic lung herniation and pericardial rupture. J Thorac Cardiovasc Surg 2007; 133:588-9. [PMID: 17258616 DOI: 10.1016/j.jtcvs.2006.09.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Accepted: 09/25/2006] [Indexed: 11/17/2022]
Affiliation(s)
- Christoph Benckert
- Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow, Universitätsmedizin Berlin, Berlin, Germany.
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11
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Patel MB, Nathan JD, Frush DP, Rice HE. Nonoperative Management of Asymptomatic Traumatic Pulmonary Hernia in a Young Child. ACTA ACUST UNITED AC 2007; 62:234-5. [PMID: 17215762 DOI: 10.1097/01.ta.0000246947.19359.3e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Mayur B Patel
- Department of General Surgery, Duke University Medical Center, Durham, North Carolina 27707, USA
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12
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Petteruti F, Pepino P, De Luca G, Griffo S, Di Tommaso L, Stassano P. An unusual case of lateral pulmonary hernia. J Thorac Cardiovasc Surg 2006; 132:189-90. [PMID: 16798336 DOI: 10.1016/j.jtcvs.2006.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2006] [Accepted: 03/15/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Francesco Petteruti
- Cardiothoracic Surgery Unit, Clinica Pineta Grande Castelvolturno, CE, Naples, Italy.
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13
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Fitzsimons MG, Baker KH, Peralta R. Anesthetic implications of traumatic pulmonary hernia repair. J Clin Anesth 2006; 17:627-9. [PMID: 16427536 DOI: 10.1016/j.jclinane.2005.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2004] [Accepted: 03/02/2005] [Indexed: 11/17/2022]
Abstract
Traumatic pulmonary herniation involves the protrusion of lung parenchyma beyond the normal borders of the thoracic cage through a defect in the musculoskeletal wall. Anesthetic management involves airway protection, lung isolation, and avoidance of distension of the herniated segment. We report the successful anesthetic management during surgical management of pulmonary herniation.
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Affiliation(s)
- Michael G Fitzsimons
- Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA.
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14
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Fackeldey V, Junge K, Hinck D, Franke A, Willis S, Becker HP, Schumpelick V. Repair of intercostal pulmonary herniation. Hernia 2003; 7:215-7. [PMID: 12740692 DOI: 10.1007/s10029-003-0135-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2003] [Accepted: 03/24/2003] [Indexed: 10/26/2022]
Abstract
Intercostal pulmonary herniation occurring years after blunt thoracic trauma is a rare phenomenon. We report on the case of a 66-year-old patient who developed a pulmonary herniation 2 years after a seat-belt injury. Thoracotomy was performed, and the thoracic wall defect was closed with approximating periostal absorbable sutures. The postoperative course was uneventful. Different surgical approaches and the use of prosthetic patches are discussed. Periostal fixation of the adjacent ribs with absorbable sutures is usually sufficient for herniation repair. In cases in which prosthetic meshes are needed, the application of PTFE might produce the best results with the least complications.
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Affiliation(s)
- V Fackeldey
- Department of General Visceral and Thoracic Surgery, Central Hospital of the German Armed Forces, Koblenz, Germany.
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15
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Rajendiran S, Kapoor V, Schoedel K. Fine-needle aspiration cytology of intraabdominal extralobar pulmonary sequestration: a case report. Diagn Cytopathol 2003; 29:24-7. [PMID: 12827711 DOI: 10.1002/dc.10302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 55-yr-old female presented with a mass near the left adrenal gland detected on a CT scan performed for breast cancer staging. A CT-guided fine-needle aspiration (FNA) was performed and showed scattered ciliated cells, compatible with benign respiratory-type epithelial cells. CT-guided needle biopsy also showed fibrocollagenous and fibroadipose connective tissue with focal respiratory type epithelium with subepithelial mucus glands. A final diagnosis of extralobar pulmonary sequestration (ELS) was rendered after surgical resection. This uncommon benign congenital malformation should be considered in the differential diagnosis of FNA of an intraabdominal mass in an adult.
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Affiliation(s)
- Swaminathan Rajendiran
- Department of Pathology, University of Pittsburgh, UPMC-Presbyterian Hospital, Pittsburgh, Pennsylvania 15213, USA.
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Abstract
Traumatic extrathoracic lung herniation is an exceptional complication of blunt chest trauma. We report the case of a 46-year-old man who was involved in a motorcycle accident and who suffered a left clavicle fracture-dislocation associated with multiple rib fractures and massive herniation of the left upper lobe through an upper anterior chest wall defect. Immediate surgical repair through an atypical transcostal vertical thoracotomy resulted in full recovery of pulmonary function at 1 year.
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