DOUBLE JEOPARDY - THORACOABDOMINAL INJURIES REQUIRING SURGICAL INTERVENTION IN BOTH CHEST AND ABDOMEN

The critical decisions in patients with thoracoabdominal trauma are es tablishing the need to explore either or both cavities and determining appropriate sequencing. The causes and patterns of management difficu lties were analyzed in 82 consecutive patients with penetrating thorac oabdominal injuries. Nine thoracotomies (11%) and 16 laparotomies (22% ) were negative, with the major causes being misleading chest tube out puts, bullet trajectories, and abdominal tenderness. Inappropriate seq uencing occurred in 19 patients (23%), and 15% required reoperation wi thin 24 hours. Pitfalls and misjudgments in management of penetrating thoracoabdominal injuries occur in distinct patterns. The unreliabilit y of chest tube output and abdominal examination must be kept in mind, and intraoperative clues of ongoing hemorrhage outside the operative field must be sought.