Chest Tube Malposition Inserted in Thorax Increases Morbidity at Thoracoabdominal Injury


Department of General and Emergency Surgery, Mugla Sitki Kocman University Hospital, Muğla, Turkey



Thoracoabdominal penetrating trauma management is challenging when diaphragm injuries are involved. Thorax tube is golden standard for penetrating thoracoabdominal injuries. It has some complications. A 27‑year‑old male had stabbed thoracoabdominal penetrating trauma thorax tube inserted at another hospital. We decided to explore abdomen laparoscopy when he has symptoms at abdomen. We saw thorax tube ruptured diaphragm. We saturated diaphragm intracorporeally with laparoscopic protege. The clinician should not insert tube from penetrating trauma area. Tube must be inserted from its usual anatomical intercostal space.


1. Asensio JA, Petrone P. Injury to the diaphragm. In: Moore EE, Feliciano DV, Mattox KL, editors. Trauma. 5th ed. NewYork: McGraw‑Hill; 2004. p. 613‑35.
2. Rosati C. Acute traumatic injury of the diaphragm. Chest Surg Clin N Am 1998;8:371‑9.
3. Kwiatt M, Tarbox A, Seamon MJ, Swaroop M, Cipolla J, Allen C, et al. Thoracostomy tubes: A comprehensive review of complications and related topics. Int J Crit Illn Inj Sci 2014;4:143‑55.
4. Chrysou K, Halat G, Hoksch B, Schmid RA, Kocher GJ. Lessons from a large trauma center: Impact of blunt chest trauma in polytrauma patients‑still a relevant problem? Scand J Trauma Resusc Emerg Med 2017;25:42.
5. Chatzoulis G, Papachristos IC, Daliakopoulos SI, Chatzoulis K, Lampridis S, Svarnas G, et al. Septic shock with tension fecothorax as a delayed presentation of a gunshot diaphragmatic rupture. J Thorac Dis 2013;5:E195‑8.
6. Scharff JR, Naunheim KS. Traumatic diaphragmatic injuries. Thorac Surg Clin 2007;17:81‑5.
7. Thiam O, Konate I, Gueye ML, Toure AO, Seck M, Cisse M, et al. Traumatic diaphragmatic injuries: Epidemiological, diagnostic and therapeutic aspects. Springerplus 2016;5:1614.
8. Meteroglu F, Sahin A, Basyigit I. Diaphragmatic injury: Condition be noticed in the management of thoracic trauma. Ulus Travma Acil Cerrahi Derg 2015;21:514-9.
9. Mehrotra AK, Feroz A, Dawar S, Kumar P, Singh A, Khublani TK, et al. Diaphragmatic rupture precipitated by intercostal chest tube drainage in a patient of blunt thoraco‑abdominal trauma. Lung India 2016;33:85‑7.
10. Laws D, Neville E, Duffy J; Pleural Diseases Group, Standards of Care Committee, British Thoracic Society. BTS guidelines for the insertion of a chest drain. Thorax 2003;58 Suppl 2:ii53‑9.
11. Millikan JS, Moore EE, Steiner E, Aragon GE, Van Way CW 3rd. Complications of tube thoracostomy for acute trauma. Am J Surg 1980;140:738‑41.
12. Içöz G, Kara E, Ilkgül O, Yetgin S, Tunçyürek P, Korkut MA, et al. Perforation of the stomach due to chest tube complication in a patient with iatrogenic diaphragmatic rupture. Acta Chir Belg 2003;103:423‑4.
13. Bowness JS, Nicholls K, Kilgour PM, Ferris J, Whiten S, Parkin I, et al. Finding the fifth intercostal space for chest drain insertion: Guidelines and ultrasound. Emerg Med J 2015;32:951‑4.
14. Bowness J, Kilgour PM, Whiten S, Parkin I, Mooney J, Driscoll P. Guidelines for chest drain insertion may not prevent damage to abdominal viscera. Emerg Med J 2015;32:620‑5.