Journal of Surgery
Volume 4, Issue 6, December 2016, Pages: 130-133

Management over Penetrating Wound of the Chest in University Hospital of Conakry

Aissatou Taran Diallo1, Alpha Kabinet Camara2, Soriba Naby Camara3, Essaga Ayissi Alphonsine Martine1, Diallo Sara Boubacar2, Ismael Kaba2, Boubacar Djello Diallo4, Mariame Béavogui5, Mohamed Kaba Touré6, Diallo Biro3

1Department of Generale Surgery, University Gamal Abdel Nasser of Conakry, Conakry, Guinea

2Department of Thoracic Surgery, University Gamal Abdel Nasser of Conakry, Conakry, Guinea

3Sservice de Chirurgie Viscérale, University Gamal Abdel Nasser of Conakry, Conakry, Guinea

4Department of Pneumology, University Gamal Abdel Nasser of Conakry, Conakry, Guinea

5Department of Cardiology, University Gamal Abdel Nasser of Conakry, Conakry, Guinea.

6Department of Anesthesia University Gamal Abdel Nasser of Conakry, Conakry, Guinea

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(A. T. Diallo)
(S. N. Camara)

To cite this article:

Aissatou Taran Diallo, Alpha Kabinet Camara, Soriba Naby Camara, Essaga Ayissi Alphonsine Martine, Diallo Sara Boubacar, Ismael Kaba, Boubacar Djello Diallo, Mariame Béavogui, Mohamed Kaba Touré, Diallo Biro. Management over Penetrating Wound of the Chest in University Hospital of Conakry. Journal of Surgery. Vol. 4, No. 6, 2016, pp. 130-133. doi: 10.11648/j.js.20160406.12

Received: October 1, 2016; Accepted: October 22, 2016; Published: November 23, 2016


Abstract: Penetrating injuries to the chest present a frequent and challenging problem. The majority of these injuries can be managed non-operatively. The aim of this study were to determine the frequency of penetrating wounds of the chest, identifying wounding agents and circumstances of the trauma occurred, describe the diagnostic and therapeutic care at the University Hospital of Conakry. Methods As part of this study was the thoracic surgery department of the National Hospital Donka Hospital in Conakry. This was a retrospective descriptive study of a type of 4 years and 8 months, from 1 January 2010 to 30 August 2015 inclusive. It involved a chart review of patients admitted consecutively in the service for penetrating trauma of Thorax. The variables studied were epidemiological, diagnostic, and therapeutic. Results: We collected 98 cases of penetrating wounds of the chest during the study period, representing 21.16% of all thoracic pathologies treated in the service during the same period (n = 463). The male occupied 87% of cases (n = 85) and the female gender was 13% (13). The average age of patients of patients was 25 years with extremes of 04 and 60 years. The age between 21 and30 years is the most represented with 59.19% (n = 58). Pupils and students were most concerned with 31.63% (n = 31), followed by workers (23.46%, n = 23), street vendors (20.40%, n = 20) and drivers (15.30%, n = 30). The wounding agents were represented by stabbing with 67% (n = 66), firearms with 26% (n = 25), and impalement on perforating agents in 7% (n = 7%). The circumstances of occurrence recorded were armed criminal assault in 87.75% (n = 86), hunting accidents with 5.10% (n = 5), brawls with 4.08% (n = 4) and falls from height with 3.06% (n = 3). Conclusion Penetrating wounds of the chest are a current pathology by increased violence, insecurity and the misuse of firearms in major cities. The vital importance of intra thoracic organs is a medical and surgical emergency.

Keywords: Penetrating, Wounds, Chest, Management


1. Introduction

The penetrating chest wound is a solution of continuity of one of the chest covering. It is penetrating said if it exceeds the parietal pleura of one or the other of the two pleural cavities or it reaches one of the mediastinal tissue. [1] Penetrating injuries to the chest present a frequent and challenging problem. The majority of these injuries can be managed non-operatively. The selection of patients for operation or observation can be made by clinical examination and appropriate investigations. The trauma ultrasound has become a valuable first-line tool to rule out pericardial tamponade [2] Penetrating trauma may affect structures not apparent by outward wounds given the path the missile may take. Regardless of the injury, there are usually changes in the patient’s ability to oxygenate and ventilate adequately. he information gathered from the prehospital setting is important. In general some important points to consider: [3] Penetrating trauma may affect structures not apparent by outward wounds given the path the missile may take. Regardless of the injury, there are usually changes in the patient’s ability to oxygenate and ventilate adequately. he information gathered from the prehospital setting is important. In general some important points to consider: [4] Motor vehicle collisions: speed, whether or not the patient was wearing a safety restraint, was their airbag deployment, their position in the car, area of impact and surrounding damage.• Motorcycle or bicyclist: if struck by vehicle and speed, if thrown and distance.• Pedestrians struck: the type vehicle and speed and if thrown and thedistance. • Penetrating trauma: the type of firearm, caliber, distance; for stab wounds, the blade length and reported force.• Keep in mind that in penetrating trauma, gunshot wounds have a less predictable pattern of injury as the missile may not follow a straight course. The effects of the "blast" may also cause injury.[5]. The physical examination should be an organized approach to include the primary survey with attention to any life threatening injuries followed by a secondary survey as taught in ATLS/ATCN courses.

40% Penetrating Injury Involves the Thorax, • 15-28% of Penetrating Thoracic Injuries Require Thoracotomy [6]

Many cases of traumatic deaths due to chest injury may be prevented by prompt diagnosis and a standardized therapeutic approach in the trauma resuscitation room. A high index of suspicion for lethal injury patterns, based on the mechanism of trauma and the clinical presentation, is a crucial to prompt diagnosis and intervention. [7]

Penetrating wounds of the chest represent 10% of chest injuries in Europe [8], with an incidence ranging from steadily increasing 5à13% [9]. In Africa the incidence of penetrating wounds of the chest was between 20 and 44% [10]. Penetrating trauma may affect structures not apparent by outward wounds given the path the missile may take. Regardless of the injury, there are usually changes in the patient’s ability to oxygenate and ventilate adequately. he information gathered from the prehospital setting is important. In general some important points to consider:.

40% Penetrating Injury Involves the Thorax, • 15-28% of Penetrating Thoracic Injuries Require Thoracotomy

Many cases of traumatic deaths due to chest injury may be prevented by prompt diagnosis and a standardized therapeutic approach in the trauma resuscitation room. A high index of suspicion for lethal injury patterns, based on the mechanism of trauma and the clinical presentation, is a crucial to prompt diagnosis and intervention.

The aim this study was to evaluate the treatment of penetrating wounds of the chest at the University Hospital of Conakry.

2. Methodology

2.1. Patients and Method

It is a descriptive retrospective study conducted in the thoracic surgery department of university hospital of Donka in Guinea Conakry from January 2010 to august 2015 inclusivelly. 107 patients were hospitalized and treated for penetrating wound of the chest.

2.2. Variable and Epidemiology Analysis

Our study involved a chart review of patients admitted consecutively in the thoracic department for a penetrating wound of the thorax. The variables studied were epidemiological, diagnostic, treatment and results on socio-demographic aspects of the victims, wounding agents and circumstances of occurrence of the accident, the clinical and radiological assessment of the lesions, the therapeutic conduct and its aftermath.

2.3. Initial Evaluation

The extent and means of the initial evaluation in the emergency room (ER) depends on the clinical condition of the victim. The patients could be divided in three groups. First, patients with cardiac arrest or imminent cardiac arrest require an immediate ER re suscitative thoracotomy without any investigations.

3. Results

Table 1. Fréquency of Penetrating wounds comparing to the others pathology in the thoracic department.

Pathology Nomber of cases( n=463) Percentage (%)
Hémothorax/ 115 24,83
Hémopneumothorax 109 23,54
Penetrating wounds of chest 98 21,16
Tuberculosis Pleuresia 65 14,03
Penetrating wounds od the thorax 32 6,91
Pyothorax 22 4,75
Pyopneumothorax 10 2,15
Spontaneous Pneumothorax 07 1,51
Péricardititis 03 0,64
Abcess of the lung 2 0,43
Total 463 100

Table 2. Distribution of the patient according to the socio-profesionnal category.

socioprofesionnal category Nomber of cases( n=98) Percentage (%)
Students 31 31.63
Workmen 23 23.46
Merchants 20 20,40
Driver 15 15,30
Housewives 6 6,12
Civils servant 3 3.06
Total 98 100

Table 3. Distribution of patient according to the Circumstances occured.

Circumstances occured Number of cases( n=98) Percentage (%)
Crimnal assault 86 87,75
Accident of hunting 5 5,10
Brawls 4 4,08
Fall a height 3 3,06
Total 98 100

Table 4. Fréquency of clinical signs.

Motif de consultation Nombre de cas N=98 %
Thoracic pain 98 100
Dyspnea 74 75,51
Emphysema 25 25,51
Hémoptysy 02 2,04
Cough 05 5,10

Penetrating wounds of the chest accounted for 21.16% (n = 98) of the entire thoracic pathologies treated in our department during the period of the study (n = 463) Table 1. We noted a male predominance (86.73%, n = 85): The mean age of patients was 25 ± 5 years, ranging from 04 years to 60 years. The age group between 21 et30 years is the most represented with 59.19% (n = 58). The most relevant socio-professional categories were pupils / students (31.63%, n = 31 cases), workers (23.46%, n = 23), street vendors (20.40%, n = 20), followed by drivers (15.30%, n = 15), housewives (6.12%, n = 6cas) and staff (3.06%, N = 3). Table 2

The most wounding agent in question was stabbed (67%, n = 66), followed by firearms (26%, n = 25) and falls on perforating agents (7.14%, n = 7).

The circumstances of occurrence were armed criminal assault in 87.75% (n = 86), hunting accidents with 5.10% (n = 5), brawls with 4.08% (n = 4) and falls from height with 3.06% (n = 3). Table 3. Clinical signs were dominated by chest pain recorded in 100% of cases (n = 98). Table 4. The standard chest X-ray was the only accessible and radiological examination was performed routinely in all patients. The lesions observed were dominated by pleural effusions: gaseous effusions (13.26, n = 13), Effusions (10.20%, n = 10), joint effusion (57.14%, n = 56), joint effusion + inclusion of foreign bodies (15.30%, n = 15), joint effusion + rib fracture). the therapeutic management was essentially based on the medical treatment and pleural drainage. All patients (100% N = 98) underwent a vascular filling made isotonic solutes and macromolecules; Thirteen point two and six percent (13.26%, n = 13) had received a blood transfusion iso group rhesus iso. The thoracic drainage was performed in 94.89% (n = 93). A drug was prescribed adjuvant therapy: analgesics (paracetamol 1g infusion every 6 hours), anti-inflammatory drugs (Diclofenac 50mg) in 100% of cases (98 =), an antibiotic made of amoxicillin + clavulanate (83.67%, n = 82), gentamicin (16.32%, n = 16). Tetanus serum was administered at 74.48% (n = 73). About 5.10% who received thoracotomy (n = 5), one (n = 1) consisted of a hemostasis in vascular injury intercostal and four (n = 4) in a lung pleural decortication.. The therapeutic outcome was favorable in 88.77% of cases (n = 87). The suites have been unfavorable in 5.10% of cases (n = 5): it was a type of morbidity empyema and pleural effusion recurrence in 4.08% of cases n = 4) and a registered lethality in 2.04% of cases (n = 2). The average length of hospital stay was 08jours with extremes of 09 and 49 days.

4. Discussion

Penetrating wounds of the chest represented 21.16% of all patients admitted to the thoracic chirurgy of the CHU from Conakry between 2010 and 2015. This rate varied in the literature between 20% [11] to 23% [12]. The average age of patients was 25 years with extremes of 4 years and 60 years. Corroborating studies Yaqini K Casablanca [13]), Shua O N'Djamena [10] and Randrianmanajara in Madagascar [11]), which have respectively reported mean age of 26 years, 27.2 years, and 27 years. This high frequency among young adults could be explained both by the hyperactivity of this layer and its mobility at any time which exposes it to risks associated with urban insecurity.

In our study, male gender (86, 73%, n = 85) was more concerned that the female gender (13.26%, n = 13) with a sex ratio of 6.43. This frequency varied in the literature of 83.17% to 95% in the S Yena studies Yaqini Guivach K. and E. [9,13,14]. This predominance of the male gender can be explained by the place of the male gender in society that the predestined to perform risky trades. Pupils and students were the first victims with a frequency of 31.63% (n = 31 cases). This observation was made by Shua O in N'Djamena and Yena S in Bamako with 39.5% and 36.4% respectively [13, 14]. It could be explained by the fact that pupils and students sometimes have a job which requires time schedules and routes at risk. It is the same peddlers whose itinerant business, expose the aggressions robbers, sometimes disguised as customers. Penetrating stab wounds were frequent etiology in our study with 67.34% (n = 66). This result was similar to that reported by Randrianmannajara to Madagascar with 53% [11]. The criminal aggression was the circumstance occurred most observed in our study and in that of Yaqini K Cassablanca [13]. In both studies the chest pain was the first clinical sign with 100% respectively (n = 98), 94.6% (n = 175). Pleural effusions with or without broken ribs were the radiological lesions in our study. The same was done in the study of Yen S in Mali. [8] Medical treatment and thoracic drainage were enough for the management of penetrating wounds of the chest in almost all cases. Indications for thoracotomy were rare, dictated by the failure of thoracic drainage bringing more than 1500 ml of blood initially or 300 ml / hour and / or hemodynamic instability despite the well pipe filling [11,13] was. L'évolution favorable in 88.77% of cases in our series (n = 87). Morbidity was observed in type pyothorax (5.10%, n = 5) and pleural effusion recurrence (4.08%, n = 4), the K Yaqini image that had reported 7% pyothorax and 43% of pleural effusions recurrence. Lethality of 2.04% (n = 2) was also observed in our study. It was the same in those of Yena S [14] and Mandal [8] which showed 9.3% lethality rates respectively (n = 8) and 2.8%. Patients had an average stay of 08jours in 79.59% cases with extremes of 01day due to death on the day of admission and 49jours for empyema occurred in the aftermath of a chest drain. This result was superimposed on that of Camara IA [9] who observed an average residence 08jours in 83% of cases with extremes of 01jours and 49jours.

5. Conclusion

Penetrating wounds of the chest are a current pathology by increased violence, insecurity and the misuse of firearms in major cities.

The vital importance of intra thoracic organs is a medical and surgical emergency.

The hope of reducing these injuries is prevention through education of the population, the implementation of civil protection and criminal deterrence measures.


References

  1. Pons F.; Arigon J.-P.; Boddaert G. Traitement chirurgical des traumatismes pénétrants du thorax.EMC paris 2011; (42): 1-26.
  2. D. Demetriades, G. C. Velmahos Penetrating injuries of the chest indication for operation. Scandinavian Journal of Surgery 91: 41–45, 2002.
  3. Asensio JA, Berne JD, Chan L, Murray J, Falabella A, Gomez H, Chahwan S, Velmahos G, Cornwell EE, Belzberg H, Shoemaker W, Berne TV: One hundred five penetrating car-diac injuries: a 2-year prospective evaluation. J Trauma, 1998;44:1073–1082.
  4. Renz BM, Cara RA, Feliciano DV, Rozycky GS: Transmedias- tinal gunshot wounds: A prospective study. J Trauma 2000; 48:416–422.
  5. Hanpeter DE, Demetriades D, Asensio JA, Berne TV, Velma-hos G, Murray J: Helical computed tomographic scan in the evaluation of mediastinal gunshot wounds. J Trauma 2000;49: 689–695.
  6. Murray JA, Demetriades D, Cornwell EE III, Asensio JA, Vel-mahos G, Belzberg H, Berne TV: Penetrating left thoracoab-dominal trauma: The incidence and clinical presentation ofdiaphragmatic injuries. J Trauma 1997;43:624–626
  7. Murray JA, Demetriades D, Asensio JA, Cornwell EE III, Vel-mahos G, Belzberg H, Berne TV: Occult injuries to the dia-phragm: prospective evaluation of laparoscopy in penetrat-ing injuries to the left lower chest. J Am Coll Surg 1998;187:626–630
  8. Mandal Ak. ; Sanusi M. Penetrating chest wounds: 24 years’ experience. World J Surg.2001; 25 (9):1145-9.
  9. GUIVARCH E. Stratégie de prise en charge des plaies thoraciques par armes blanche dans un décochage. (Une série consécutive de 153patients). Mémoire d’anesthésie - réanimation à l’institution d’anesthésie et réanimation de paris 2013; 6-40.
  10. Choua O; Rimtebaye K; Adam A.M; Bekoutou G, Anour M. A. Plaies pénétrantes par arme blanche et arme à feu à N’Djamena Tchad : une épidémie silencieuse?European Scientific Journal February 2016; 12(9): 180-188.
  11. Randriamananjara. H; Ratovoson. A. Plaies pénétrantes du thorax: Bilan d notre prise en charge en urgence. À propos de 151 observations colligées dans le service de chirurgie générale et thoracique du Centre Hospitalier d’Ampefiloha (Madagascar) Méd.D’Afrique noire 2001; 48(6): 1-4.
  12. Debien B; Lenoir B. Traumatismes pénétrants du thorax.Urgences- 2004; (1): 297-312.
  13. Yaqini K.; Guartite A.; M.Mouhaou. Prise en charge des plaies thoraciques par arme blanche au service d’accueil des urgences de Casablanca. Journal maghrébin d’anesthésie- réanimation et de médecine d’urgence 2003; 10 (43): 255-257.
  14. Yena S.; Z Sanogo Z.; Sangared D.Les traumatismes thoraciques à l’hôpital du point "G" Mali médical 2006; 21 (1): 43-47.

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