Characterizing a Safe Approach to Timing of Elective Abdominal Surgery Following Traumatic Pneumothorax: A Case Report and Review of the Literature

A traumatic pneumothorax is a potentially life-threatening injury that can occur following chest trauma. For large pneumothoraces, the standard of management is decompression with intercostal catheters to avoid significant outcomes such as tension pneumothorax and obstructive shock. This is well described within trauma guidelines; however, there remains a lack of consensus about the appropriate time to undergo safe surgery following the resolution of a traumatic pneumothorax. The approach to decompression involves careful considerations in balancing risks and benefits to the patient, namely that of re-accumulation of a pneumothorax with positive-pressure ventilation balanced with the benefit of undergoing surgery. Herein, we report a case that highlights key decision-making surrounding the time to safe surgery following the resolution of a traumatic pneumothorax for a patient with a new diagnosis of a malignant renal lesion. Our case highlights two key messages: (1) Safe elective abdominal surgery can be performed after 4 weeks from resolution of a traumatic pneumothorax and (2) Multidisciplinary collaboration of perioperative and operative clinicians, including forward planning with the presence of chest decompression equipment at the time of surgery, is highly important to allow efficient and timely management of potential reoccurrence of a pneumothorax.