Traumatismo Toracoabdominal Penetrante: Que Cavidad Operar Primero?

Abstract

mortalidad. En el grupo II predominaron las HAF transfixiantes de la línea media. En 8 casos se registró un error al abordar primero la cavidad con lesiones menos graves (en 4 casos el tórax y en 4 casos el abdomen), falleciendo 7 de los mismos y determinando una mortalidad de 25,8% para el grupo II. El análisis del error en esos 8 casos hallo que en 5 fue potencialmente prevenible y que estuvo relacionado con resultados erróneos de la ecografía y/o subestimación del débito del drenaje pleural y de la radiografía de tórax post-drenaje pleural. Conclusione: Los pacientes con TTAP y hemodinámicamente compensados presentaron predominio de HCP del lado izquierdo y no tuvieron errores en el manejo secuencial de cavidades ni mortalidad. En cambio en aquellos con TTAP y shock, predominaron las HAF y los trayectos transfixiantes de la línea media, y este grupo fue el que tuvo exclusivamente los errores de manejo y la mortalidad. La mayoría de los errores en el manejo fueron considerados potencialmente prevenibles dado que se relacionaron con resultados falsos de la ecografía y con subestimación del débito del drenaje pleural y de la radiografía de tórax post–drenaje pleural. Characteristics of patients with PTAT with a sequence of combined surgical interventions. • Characteristics of the error due to inappropriate sequence of said operative procedures. • Relationship of these previous factors with mortality. Design: Observational retrospective. Materials and methods: Review of the medical records of the patients assisted in our institution between January 2005 and December 2018, with PTAT that required operative procedures both in the chest (pleural drainage or thoracotomy) and in the abdomen (laparotomy or laparoscopy). Results: Seventy-nine patients with PTAT, 48 with normal hemodynamics (group I) and 31 with hypovolemic shock (group II) were assisted. In group I, SW (40) predominated over GSW (8), and lesions on the left side (42) (87.5%). In this group, there were no errors in sequential surgical management and no mortality was recorded. In group II, transfixing GSW of the midline predominated. In eight cases, an error was recorded when first approaching the cavity with less serious injuries (in four cases the thorax and in four cases the abdomen), seven of them died and determining mortality of 25.8% for group II. The analysis of the error in these eight cases found that in five it was potentially preventable and that it was related to erroneous results of the ultrasound and/or underestimation of the output of the pleural drainage and of the post-pleural drainage chest radiograph. Conclusion: Patients with PTAT and hemodynamically compensated presented a predominance of left-sided SW and had no errors in the sequential management of cavities or mortality. On the other hand, in those with PTAT and shock, GSW and transfixing paths of the midline predominated, and this group was the one that had exclusively the handling errors and mortality. Most of the errors in management were considered potentially preventable since they were related to false results of the ultrasound and underestimation of the output of the pleural drainage and of the post-pleural drainage chest radiograph.