Spontaneous hemopneumothorax: experience with early surgical management of two clinics

Objective: SHP is an uncommon clinical disorder that is potentially life threatening due to rapid lung collapse and blodd loss into pleural cavity. . Early surgical internention for SHP is a life saving procedure, and avoids complications such as atelectasis, restrictive lung disorders, infection of residual hematoma and reduce the incidence of delayed surgical exploration and decortication. We herein report a retrospective study in order to evaluate our demographic records, intraoperative findings, surgical methods and clinical experience of early surgery. Method: We initially included all patients with primary spontaneous pneumothorax attending the clinics of Dicle University Faculty of Medicine, Diyarbakir, Turkey and Cukurova UniversityFaculty of Medicine, Adana, Turkey. From June 2003 and December 2018, a total of 802 patients were diagnosed as spontaneous pneumothorax. After thoracocentesis, twenty four of them were diagnosed with SHP of whom sixteen underwent an prompt thoracotomy or VATS. We retrospectively collected demographic characteristics, clinical presentations, admitting time intervals, initial chest tube drainage, surgical strategies, intraoperative findings and medical history for all SHP patients. Results: Female / Male ratio was 1/23. Ranging in age from 16 to 54 years (mean age, 25,6 years). Five patients were underwent urgent operation because of hypovolemic shock and amount of blood drainage. Other 11 patients were underwent operation within 24 hours. Ten patients underwent thoracotomy, and 6 underwent VATS. Remain 8 patients were treated with tube thoracostomy. During the operations, source of hemorrhage was detected; apical abberant vessel in 7 patients, torn of parietal pleura in 6 patients and ruptured vascularized bullae/lung parenchyma in 3 patients. No recurrence of SHP occured with these 24 patients during the follow-up period. Conclusions: Early surgery should be performed in patients who are hemodynamically unstable or continuous bleeding from pleural drain. Both, VATS and minithoracotomy are appropriate tecniques for surgery.