MANAGEMENT OF COMBINED PENETRATING CARDIAC AND ABDOMINAL-TRAUMA

This is a retrospective review of patients with combined penetrating c ardiac and abdominal trauma. Clinical presentation patterns are descri bed and a management strategy is outlined. The series comprises 25 pat ients. On the basis of the mechanism of injury and the prognosis, the patients were divided into two groups: 'low risk' (single high epigast ric stab wound) and 'high risk' (multiple stabs, single or multiple gu nshot wounds). There were sh patients in the low-risk group. Their int ra-abdominal injuries were moderately severe. None of this group died. There were 19 patients in the high-risk group. Three underwent emerge ncy-room thoracotomy and died. Of the remaining patients, four underwe nt a thoracotomy first for cardiac tamponade or massive haemothorax an d 12 underwent a laparotomy first because of massive haemoperitoneum. The mortality in this group was 63 per cent. It is essential to recogn ize the cardiac injury in low-risk patients; the cardiorrhaphy midst b e performed before the laparotomy. In high-risk patients, the sequence of operations depends on the clinical presentation. Obvious cardiac t amponade or massive haemothorax mandate a thoracic approach first, whi le severe hypovolaemic shock with a massive haemoperitoneum justifies the performance of a laparotomy first; a transdiaphragmatic pericardio tomy is useful, in these cases, before proceeding to median sternotomy . (C) 1997 Elsevier Science Ltd.