Blunt thoracic aortic injury: challenges of open repair

Dinesh Gurung,Kajan Raj Shrestha,Krishnaprasad Bashyal,Uttam Krishna Shrestha

doi:10.3126/jssn.v23i1.33557

Abstract

Thoracic aortic injuries are fatal with less than 50% patients surviving beyond 24 hours even after reaching the hospital if approach is delayed. Rapid transportation, adequate resuscitation, prompt radiological diagnosis, and urgent repair significantly improves outcomes. Even after a food repair, complications such as spinal cord ischemia causing paraplegia and acute lung injury significantly increase the morbidity. Thoracic endovascular repair may appear to be superior to open repair, but its long-term results and efficacy are not well established. We present our experience with open repair in managing this challenging acute emergency and certain measures to avert common but grievous complications.

Highlights

As per the Global Burden of Disease Study of 2017, road WUD൶F DFFLGHQWV 57$ DQG WUDXPD ZHUH UHVSRQVLEOH IRU 16,831 deaths in Nepal
Blunt thoracic aortic injuries (BTAI) are the second commonest cause of mortality amongst RTA patients as most of them succumb to exsanguination at the site of accident itself
We present an unusual cause of grade IV BTAI in a young male which he sustained while on the job and our experience managing this almost fatal, rare injury with an open approach

Summary

Introduction

As per the Global Burden of Disease Study of 2017, road WUD൶F DFFLGHQWV 57$ DQG WUDXPD ZHUH UHVSRQVLEOH IRU 16,831 deaths in Nepal. A 21 years old male was brought to the emergency department of our hospital (Manmohan Cardiothoracic Vascular and Transplant Center) in a state of shock History revealed that he was trapped under a huge pile of mud while working, after which he started complaining of heaviness LQ FKHVW EDFNDFKH GL൶FXOW\ LQ EUHDWKLQJ DQG GL]]LQHVV There was no history of loss of consciousness. From the third post-operative day onwards, he started developing highgrade fever with expectoration of sero-purulent sputum which was sent for culture and sensitivity (c/s). He was reintubated on the 5th day following persistent fall in oxygen. The patient gradually started improving and was ZHDQHGR൵RIYHQWLODWRULQQLQHGD\VDQGDIWHUFRPSOHWLRQ of the course of intravenous antibiotics he was discharged on the 21st post-operative day (POD)

Discussion

Findings

Conclusion