Pericardial Injury With Cardiac Tamponade From Multiple Stab Injuries of the Trunk: Incidental Release of Cardiac Tamponade

From a regional local hospital, a 34-year-old man who had schizophrenia was transferred to our institution with multiple stab injuries of the trunk, sustained in a suicide attempt (Fig. 1.). At admission, the patient’s vital signs were unstable; cardiac arrest occurred, and return of spontaneous circulation was achieved after one cycle of cardiopulmonary resuscitation. The extended focused assessment sonography in trauma revealed positive signs in the pericardium and splenorenal space. Computed tomographic scans taken at the previous hospital showed hemopericardium and hemoperitoneum (Fig. 2.). Emergency surgery of the chest and abdomen was begun simultaneously. During opening of the chest with median sternotomy, cardiac arrest occurred again; We performed open cardiac massage, and spontaneous circulation resumed. The surgical finding was a complete transection of the left internal mammary vessels, which was the cause of hemopericardium (Fig. 3.). The epicardium of the right ventricle, the greater omentum, and the spleen were injured; the diaphragmatic injury may have served as a pericardial window of injury into the abdomen cavity. We performed ligation of the left internal mammary vessels, splenectomy, omentectomy, and primary repair of the diaphragm. The patient recovered and was discharged without any complication 24 days after admission (Fig. 4.).