The spectrum of visceral injuries secondary to misplaced intercostal chest drains: experience from a high volume trauma service in South Africa.

Abstract

Iatrogenic visceral injuries (IVI) secondary to the insertion of an intercostal chest drain (ICD) are well documented, but are usually confined to case reports and small series. We reviewed our experience with 53 consecutive patients over a insertion seven year period who sustained an IVI secondary to an ICD and describe the spectrum of injuries and clinical outcome in a high volume trauma service in South Africa. A total of 53 ICDs were inserted in 53 patients, 83% (44/53) of which were on the left side, and 17% (9/53) on the right side. 92% (49/53) of the patients were males and the mean age for all patients was 24 (±8) years. 85% of the patients were referred from rural hospitals, the remaining 15% were treated initially at our institution. A trocar was used in 75% (40/53) of patients and in 9% (5/53), a trocar was not used, 58 organ injuries occurred in 53 patients. 92% (49/53) of patients sustained a single organ injury and 4 sustained multiple injuries. The three most common injuries were: diaphragm (36%, 21/53), gastric (22%, 13/53), and pulmonary (12%, 7/53). Other injuries were: 6 (10%) spleen, 4 (7%) liver, 2 (3%) colon and 1 (2%) kidney. Three (5%) sustained an injury to the intercostal artery and one (2%) sustained a pulmonary artery injury. 39 patients (74%) required operative interventions which included laparoscopy: 20 (51%), laparotomy: 8 (21%), thoracotomy: 8 (21%), VAT: 3 (8%). A total of 28 patients (53%) developed further complications: 13 wound sepsis, 7 pneumonia, 6 empyema, 2 ARDS. and 15% (8/53) required intensive care admission. The mean length of hospital stay was 7 (±4) days. IVI is associated with significant morbidity, with diaphragmatic, gastric and pulmonary injuries being the most common. The majority were inserted in the rural hospitals and were associated with use of a trochar, Level of evidence: III, Study type: Retrospective study.