2008, Number 3
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ABSTRACTThe case of a 30 years-old male patient who was admitted to the Mexican Red Cross Trauma Center due to a vehicle-pedestrian impact is presented. The patient became unconscious, but no further kinematics of the trauma was known. At his arrival at the shock trauma room the patient was hemodynamically unstable, with periods of apnea and a Glasgow score of 6. After he was intubated, a right chest tube was placed due to pleural effusion, with drainage of 1000 ml bloody fluid. A peritoneal lavage revealed 50,000 erythrocytes/ml. The patient continued unstable, with an outflow through the chest tube of 500 ml in the first 30 minutes. He was submitted to a right anterolateral thoracotomy, which revealed a diaphragm rupture and grade IV liver injuries in segments VII and VIII, with profuse bleeding. An exploratory laparotomy unveiled hemoperitoneum of 1500 ml. A perihepatic packing was placed and the diaphragm injury was repaired. Pericardial opening was decided due to pericardial enlargement, leading to identification of a right atrium injury that was repaired with non-absorbable suture. Patient presented ventricular fibrillation. Direct cardiac massage was initiated and advanced reanimation maneuvers were performed during 15 minutes, which turned to be unsuccessful and the patient died in the surgery room. The objective of presenting this case is the association of abdominal and thoracic injuries, which are uncommon and poses difficulty diagnosis.
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