Original CommunicationsTransmediastinal gunshot injuries*
Section snippets
Patients and methods
Baragwanath hospital with 3000 beds is the largest teaching hospital attached to the University of the Witwatersrand. From January 1993 to June 1998, a retrospective study was undertaken of all patients with potentially transmediastinal gunshot injuries. This group of patients included: (1) patients in whom the bullet entered one hemithorax and exited on the opposite side; (2) patients in whom the bullet was seen on chest x-ray film lodged in the mediastinum or the opposite hemithorax. Patients
Results
In 3 patients who lost their vital signs while being transported from the scene, cardiopulmonary resuscitation was terminated on arrival to hospital. No further active resuscitative measures were taken. Seven patients lost their vital signs on arrival at the hospital or during resuscitation in our emergency department. These patients underwent emergency department thoracotomy. Six of the 7 patients died. The heart was the main source of bleeding in 2, the aorta in 3, and a combined injury of
Discussion
Transmediastinal gunshot injuries are becoming more common because of the increased spread of firearms and have not been frequently reported in the literature. During the last two decades, only a few studies have been published about this injury.2, 3, 4 Therefore several questions have to be answered regarding the correct management of the patients so there can be a decrease in its high mortality rate.
It would have been interesting to know what percentage of patients with transmediastinal
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Cited by (29)
Transmediastinal gunshot wounds in a mature trauma centre: Changing perspectives
2013, InjuryCitation Excerpt :Nagy et al.4 reported a 16% incidence of significant occult injuries in their stable cohort of patients. Degiannis et al.3 reported 42% of occult injuries among initially stable patients. Richardson et al.6 observed an occult injury in 63% of their stable patients.
Triage and Outcome of Patients with Mediastinal Penetrating Trauma
2007, Annals of Thoracic SurgeryCitation Excerpt :The operative mortality was 25% for patients who survived long enough to transfer to the operating room. This is similar to the results in several small series of transmediastinal gunshot wounds, where the operative mortality for unstable patients was 20% to 36% [4–6]. Selective management of transmediastinal gunshot wounds was first proposed in 1981 by Richardson and colleagues [4] and has become the standard for the current management of stable patients.
Screening helical computed tomographic scanning in haemodynamic stable patients with transmediastinal gunshot wounds
2007, InjuryCitation Excerpt :Evaluation of patients with TMGSWs remains a challenge to the trauma surgeon. Haemodynamically unstable patients generally have potentially lethal cardiac or vascular injuries and require immediate surgery.1,2,6,8 Haemodynamic stable patients can be uninjured, or have occult vascular, oesophageal and cardiac injuries.
Main esophagial pathology in children
2004, EMC - PediatriePenetrating vascular trauma in Johannesburg, South Africa
2002, Surgical Clinics of North America
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Reprint requests: E. Degiannis, MD, FRCS, Department of Surgery, Medical School, 7 York Road, Parktown 2193, Johannesburg, Republic of South Africa.