Chest
Volume 104, Issue 6, December 1993, Pages 1897-1898
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selected reports: Case Reports: Journal Article
Delayed Perforation of the Esophagus by a Closed Thoracostomy Tube

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We report on a previously undocumented complication of a trocar-free thoracostomy tube—delayed perforation of a normal esophagus. The complication presented clinically with fever and copious enteric drainage four days after thoracostomy tube insertion. Diagnosis was established by a contrast study of the esophagus. Retrospectively, the postinsertion chest radiograph showed the offending thoracostomy tube tip impinging on the posterior mediastinum, displacing an indwelling nasogastric tube. Early recognition and repositioning of the thoracostomy tube is the key in preventing this rare but serious complication.

Section snippets

CASE REPORT

A 25-year-old male patient was transferred to our facility 18 h following a motor vehicle accident. He was an unrestrained driver of a car who lost control and struck a telephone pole at high speed. On presentation, the patient was in hypovolemic shock with multiple blunt injuries. These included severe head trauma (Glasgow coma score of 4), multiple rib fractures with a right flail chest and hemothorax, abdominal trauma with a positive peritoneal lavage, and multiple pelvic fractures. A

DISCUSSION

The complications of tube thoracostomy can be divided into two categories: (1) technical, and (2) infectious. The technical complications can be further subdivided into the following: (a) inadequate function as a result of malposition or undersuction/oversuction, and (b) injury to chest wall structures, and intrathoracic or intra-abdominal viscera.1, 2, 3 In the latter category, injury to the intercostal vessels is the most common, followed by laceration of the lung, diaphragm, stomach, liver,

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