МАССИВНОЕ РЕЦИДИВНОЕ КРОВОТЕЧЕНИЕ ИЗ РАНЫ ПЕЧЕНИ У ПОСТРАДАВШЕГО С СОЧЕТАННЫМ КОЛОТО-РЕЗАНЫМ ПОВРЕЖДЕНИЕМ ГРУДИ И ЖИВОТА

2018 
Objective – to discuss the specific features of surgical treatment in a patient with stab wounds of the heart and liver. Materials and methods . We present the results of treatment of the patient with clinical diagnosis "Polytrauma. Thorax stab-cut wound to the right, penetrating the pleural cavity. Injuries to the right atrium, internal thoracic artery, and lung segment V. Right-lateral middle hemopneumothorax. Stab-cut wound of the abdomen, penetrating the abdominal cavity, injury to the liver segment VI, hemoperitoneum. Compensated hemorrhagic shock. Severity of injuries: ISS = 34, RTS = 6.8, TRISS – 883 %". The sequence of surgical intervention and the difficulties of final hemostasis in knife wound with deep penetration into the liver parenchyma including the damage of segmental tubular structures are discussed. Results . The first stage of surgical treatment – closure of the heart and lung wounds, ligation of the internal thoracic artery – was completed successfully. Liver wound closure was not effective, and hemorrhage recurred in the early postoperative period. Following relaparotomy, the final hemostasis was provided by ligation of the 5th segment of the artery along its distance. The patient was discharged in satisfactory condition on the 15th day after hospital admission. Conclusion . Hence, in a combined cut wound of the chest and abdomen with suspected heart injury, the first stage of surgery included thoracotomy, which revealed three sources of bleeding: the right atrium, the internal thoracic artery, the 5th lung segment. At the second stage, the liver suturing without finger and visual revision of the wound canal caused recurrent bleeding into the abdominal cavity, which was timely diagnosed. Final hemostasis was achieved after ligation of segmental artery along its distance. Heart and liver functional examination in the postoperative period did not find any disorders.
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