A Case of Penetrating Hepatic Trauma Caused by Secondary Blast Injury

Abstract

Introduction: The damages of the explosion are classified as four-phases and secondary damage is penetrating trauma by flying objects. Here, we illustrate a rare case of penetrating hepatic trauma caused by secondary blast injury. Case: The patient was a 58-year-old man. When he was walking in the park, an explosion occurred behind him. Although his consciousness was clear and vital signs were almost normal, he had an about 2cm wound on right 6th intercostal space and bleeding. Imaging showed a right hemopneumothorax, a fracture of the 7th rib, a circular foreign body near the right diaphragm, free air and hemorrhage due to liver injury. Hepatic hemorrhage was stopped by IVR. However, we decided to perform laparotomy. This is because we had to confirme intestinal damage and remove the foreign body which was doubt to cause the the chemical substance. We performed laparotomy with J-incision and thoracotomy at the 7th intercostal space. We found the foreign body in the thoracic cavity. It suggested that the foreign body passed and damaged from ribs, lungs, diaphragm, liver, diaphragm and lungs, sequentially. The foreign body was 3cm metallic washer. With regarding to the two hepatic injuries, collagen hemostat was placed into liver damaged area and Felt was put on the sutured line by using 2 PDS. There was a bile leak after surgery, which gradually settled down with endoscopic treatment, and he was discharged 43 days after the operation. Conclusion: In blast injury, accurate diagnosis and the timing of operation were important.