Penetrating Stab Injury of the Thoracic Aorta
A36-year-old male psychiatric nurse was stabbed in the back with a knife by a patient suffering from acute psychosis. After initial treatment in an outside hospital, he was transferred in stable cardiopulmonary condition to our department because a lung injury was suspected (Figure 1⇓).
Computed tomography performed while the knife was still in place showed that the blade had penetrated the proximal part of the descending aorta. A periaortic hematoma had developed, but no injury of the lung parenchyma was demonstrated (Figure 2⇓).
The patient was transferred immediately to the operating room, and an exploratory thoracotomy was performed using left-heart bypass through femoral cannulation as an adjunct. After cross-clamping the aorta, a longitudinal arteriotomy was performed in the anterior part of the vessel wall, and the tip of the blade, which had injured two-thirds of the circumference, was exposed (Figure 3⇓).
After removal of the knife, the posterior wall was closed from inside using a running polypropylene suture. The aortotomy was closed in a similar fashion, and the patient was weaned from cardiopulmonary bypass without problems. Postoperative recovery was uneventful, and the patient was discharged 5 days after the surgery.
- Copyright © 2000 by American Heart Association