Intraoperative sonography to exclude thoracic injury

Abstract

The authors present the case of a 29-year-old female with stab wound to the abdomen. After the initial fluid resuscitation and preliminary radiographic examinations immediate laparotomy was indicated due to hypovolaemic circulatory collapse. Splenectomy and gastric suture were necessary. Following the urgent interventions a wound of the left diaphragm was noticed during the extended abdominal exploration. According to the prior examinations and the operative situation it was not clear whether the injury is penetrating. In order to avoid explorative thoracotomy intraoperative ultrasonography was performed: the transducer and the acoustic gel were placed into sterile plastic bag and the organs above the diaphragm were examined from the abdominal cavity. With this method intrathoracic injury close to the diaphragm could be clearly excluded.