A Rare Presentation of Hemothorax due to Left Hemithorax Penetrative Wound: An Operative Approach Requiring Segmentectomy

Adhia Endrika; Romy Deviandri; Ade Wirdayanto; Fakhrul  Hendra; Briliant Briliant; Andrea  Valentino

doi:10.28932/jmh.v8i1.11791

Authors

Adhia Endrika Residen Bedah, Departemen Bedah, Fakultas Kedokteran, Universitas Riau
Romy Deviandri Departemen Bedah Ortopedi, Fakultas Kedokteran, Universitas Riau
Ade Wirdayanto Departemen Bedah Saraf, Fakultas Kedokteran, Universitas Riau
Fakhrul Hendra Departemen Bedah Plastik, Fakultas Kedokteran, Universitas Riau https://orcid.org/0009-0002-8345-2629
Briliant Briliant Departemen Bedah Kardiotoraks, Fakultas Kedokteran, Universitas Riau
Andrea Valentino Departemen Bedah Saraf, Fakultas Kedokteran, Universitas Riau https://orcid.org/0009-0004-5169-9824

DOI:

https://doi.org/10.28932/jmh.v8i1.11791

Keywords:

hemothorax, preventable death, penetrating wound, thoracotomy, traumatology

Abstract

Hemothorax is a medical emergency as blood accumulates inside the pleural space due to spontaneous, iatrogenic, or traumatic etiology. In general, hemothorax has a good prognosis. But severe hemothorax, especially those in vital areas, can lead to more invasive management. This case report aims to explore the presentation of massive hemothorax due to penetrative trauma and discuss suitable management approaches. A 16-year-old patient came due to spear wound through the left shoulder without exit wound. From primary assessment we found subcutaneous emphysema in the left lung, without compensation in airway and circulation system. A thoracocentesis intervention promptly performed as initial treatment. Secondary management proceeded with surgical thoracotomy which resulted in segmentectomy. Around 2-6% of patients of hemothorax patients need surgical intervention, and less than 2% will need segmentectomy intervention due to bleeding that cannot be corrected with surgical ligation. This case is one of the rare cases of hemothorax with segmentectomy. Although this patient did not have any respiratory nor circulatory complication, laceration in proximal hilum area leads to massive bleeding that damaged the lung parenchyma. Vigilant assessment in patients with penetrative trauma, especially in the left hemithorax, is essential to diagnose possible complication and execute evidence-based management plan.

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