POST TRAUMATIC EMPYEMA

Abstract

Objective: To evaluate the possibility of empyema posterior to thoraco-abdominal trauma associated to hollow viscus and diaphragmatic injuries, in the service of Surgery 2, Hospital Domingo Luciani, Caracas. Patients and method: It is a retrospective, descriptive and
transversal study done in the period between years 2002 to 2008. From 304 patients admitted with diagnosis of thoracoabdominal
trauma, there were analyzed 40 clinical records of those who presented diaphragmatic injury, evaluating the treatment performed to thoracic injuries and its follow-up. Results: There were 39 male patients (97,5 %) and 1 female, with age between 13 and 60 years old (average: 27,9).
Mechanism of lesion were: gunshot wound in 33 patients (82,5 %), stab wound 6 (15 %), and blunt trauma 1 case (2,5 %). All the patients were managed with a chest tube placement. In 3 patients an exploratory thoracotomy was performed. There were reported 3 cases of empyema, all of them in the chest tube group. Hollow viscus injury, hemodinamic instability, and ATI > 30 were the most important risk factors found.
Conclusions: In a thoraco-abdominal trauma with hollow viscus and diaphragmatic injuries, thoracic contamination is highly possible. Only a chest tube thoracostomy could be unsatisfactory for a cleaning of the pleural space.