Do najczęstszych obrażeń klatki piersiowej i jamy brzusznej dochodzi w konsekwencji ran drążących. Należy je brać pod uwagę, jeżeli wlot i wylot rany znajduje się w okolicy międzyżebrowej. Dowiedz się, które obszary jamy brzusznej są szczególnie narażone na wystąpienie skojarzonych obrażeń klatki piersiowej i brzucha.
Skojarzone obrażenia klatki piersiowej i jamy brzusznej należy rozważać, jeżeli wlot lub wylot rany znajduje się poniżej IV międzyżebrza od przodu klatki piersiowej, poniżej VI międzyżebrza w linii pachowej środkowej, a także poniżej VII międzyżebrza z tyłu.
W przypadku ran klatki piersiowej po lewej stronie ciała, nierzadko skojarzone są one z obrażeniami śledziony, żołądka i okrężnicy. Natomiast urazy w prawej części są często związane z urazem wątroby. Obrażenia te kwalifikuje się jako ciężkie. Dodatkowe ryzyko pogorszenia stanu chorego występuje w sytuacji, jeżeli zostały uszkodzone narządy po obu stronach.
Jakie badania potwierdzą skojarzone obrażenia klatki piersiowej i jamy brzusznej?
Podczas diagnostyki wykonywane są przede wszystkim badania obrazowe i drenaż klatki piersiowej. Jeżeli doszło do skojarzonych obrażeń klatki piersiowej i jamy brzusznej, niezbędny będzie zabieg operacyjny.
Obrażenia klatki piersiowej są zazwyczaj możliwe do opanowania dzięki drenażowi. To sprawia, że możliwe jest przeprowadzenie laparotomii i zajęcie się najpierw obrażeniami w obrębie jamy brzusznej.
W przypadku konieczności leczenia operacyjnego obu obszarów, najlepiej sprawdza się zaopatrzenie urazów z dwóch osobnych cięć, w obszarze klatki piersiowej – torakotomii oraz jamy brzusznej – laparotomii.
Źródło: Głuszek S., Chirurgia Podstawy, Wydanie II uaktualnione i rozszerzone Warszawa 2019, s. 118
Przeczytaj także: Postępowanie w przypadku urazu przepony
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