Revista de Ciencias de la Salud
Procedure
He was carried to the operating ward and we performed a surgical cleaning, reduction and
osteosynthesis and placement of external tutors. The approximate bleeding was 1000 mL. It
concludes without complications and two concentrates of red blood cells were passed.
First post-surgical day
Patient with favorable evolution, conscious, begins feeding with soft a diet.
Post-surgical day
Stable during morning hours, general diet at lunch. Subsequent to this, Glasgow 15, with mild
respiratory distress, tachypnoea (23 per minute), tachycardia (118 per minute), has high
arterial pressures ranging from 150/80 to 180/100 mmHg, oxygen saturation to the
environment 88 %, for this reason we decided to put oxygen, 3 liters per minute through
oxygen mask. Vesicular murmur abolished in left hemithorax. It is maintained with high arterial
pressures and support of oxygen.
Supplementary examinations
Red blood cells 3 640000 mm
3
, Hemoglobin 11.6 g/dL, Hematocrit 34 %, Platelets 112.000
mm
3
, Leukocytes 10.390 mm
3
,PMN 75.3 %, Lymphocytes 11.5 %, Monocytes 10.9 %,
Basophils 0.10 %, Prothrombin time 12.50 seconds, Thromboplastin time 26.30 seconds, D
Dimer 1553 ng/mL, TGO 125 IU/L, TGP 69 IU/L, Urea 39 mg/dL, Creatinine 0.82 mg/dL.
Thoracoabdominal TAC is performed. Figure 2 shows in the left, a diaphragmatic hernia, the
left lung collapsed, presence of stomach and peritoneal fat in the left hemithorax, stable
fracture of eighth left rib.
Thoracic surgery was reported, and after assessment by a specialist, he decides to intervene
and perform left lateral emergency thoracotomy and diaphragmatic plasticity after exploring
and finding a defect of 15 cm in diameter, and stomach and omentum in left hemithorax,
reducible, no signs of ischemia (See Figure 3 and 4).
The operation concludes without any problem, before leaving the drainage pipe. On the
second postoperative day, a standard chest X-Ray is performed (See Figure 5), where the
trachea is observed in the normal position, as well as the left hemithorax. Subsequently, the
patient was with good evolution until medical discharge on the 5th postoperative day.
Qhalikay. Revista de Ciencias de la Salud 3 (2017) 104-113
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