病例報告—青少年的泌尿系統創傷如何造成血胸?
陳秉韜1,4賴建名1 張浚峰1 倪英睿1 王強庭1,3 梅健泰1 李蕎青1,2
1國軍高雄總醫院外科部泌尿外科
2國軍高雄總醫院屏東分院泌尿外科
3國軍高雄總醫院岡山分院泌尿外科
4高雄榮民總醫院外科部泌尿外科
Case report--How major genitourinary trauma lead to hemothorax in one teenager?
Bing-Tau Chen1,4, Chien-Ming Lai1, Chun-Feng Chang1, Ying-Ray Ni1, Chiang-Ting Wang1,3, Chien-Tai Mei1, Chiao-Ching Li1,2
1Division of Urology, Department of Surgery, Kaohsiung Armed Force General Hospital
2Division of Urology, Pingtung branch, Kaohsiung Armed Force General Hospital
3Division of Urology, Gangshan branch, Kaohsiung Armed Force General Hospital
4Divsion of Urology, Depart of Surgery, Kaohsiung Veterans General Hospital
Abstract:
One 16-year-old teenager suffering from traumatic thoraco-abdominal blunting injury was sent to emergent room. Initial conscious disturbance and desatuation with hypotension were found. After emergent endotracheal insertion, series image examination showed multiple severe findings including left ribs fracture with hemopneumothorax and grade V left renal injury. After chest tube intubation, massive blood was blowout. Exploratory thoracotomy was arranged immediately by chest surgeon.
During operation, a lot of blood in the thoracic cavity obscured the view. However, no obviously active bleeding of thoracic vessels was noted. After all, ruptured diaphragm with retroperitoneal bleeding was revealed. Then the urology team took control of the scene. Avulsion of left renal artery with complete devascularization of left kidney was found. For damage control, simple nephrectomy was performed.
Diaphragmatic injuries are uncommon, especially with high grade of renal injury. Here we report this rare case, and review literature to figure out more associated information and treatment.