Complications - Tube thoracostomy, open - general and visceral surgery
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Intraoperative complications
Lung injury
Particularly when inserting the chest tube with a stylet, this can easily injure the pulmonary parenchyma. If the injuries are small, they often go unnoticed. However, injuries to the pulmonary parenchyma may result in significant bleeding complications which may only be controlled by surgical hemostasis (emergency thoracoscopy or thoracotomy). Therefore, it is best to insert the chest tube without a stylet.
Injury to intercostal nerves and vessels
This complication can be avoided by always dissecting strictly along the upper aspect of the rib and avoiding any contact with the inferior aspect of the rib immediately superior because the intercostal vessels and nerves course there. However, this is often difficult, especially in thin patients and with large-caliber chest tubes. In these situations, special caution is therefore advised and, if necessary, a different thoracostomy site with a taller intercostal space should be sought. In case of any bleeding despite these precautions, extend the skin incision and place a suture ligature around the vessel.
Injury to intraabdominal or intrathoracic organs
If the thoracostomy site is too far caudad, this may result in accidental penetration of the peritoneal cavity and organ injuries.
Left tube thoracostomy may injure the heart as the pericardium can extend to the lateral chest wall.Perforation of the diaphragm
Inappropriate handling may perforate the diaphragm with the chest tube or stylet, resulting in organ perforation and bleeding. For this reason, avoid inserting the chest tube with the stylet. Surgical management is indicated for diaphragmatic injuries.
Postoperative complications
Fistula formation
Pulmonary fistula: Injuries to the pulmonary parenchyma may result in formation of a permanent fistula.
Pleural fistula: The subcutaneous tunneling may not have achieved an adequate sliding effect of the soft tissue layers. Chest tube removal may then result in formation of a pleural fistula.Wound infection
Local inflammation may occur at the insertion site. Conservative therapy usually suffices.
Subcutaneous emphysema
Its usual causes include: Overlooked or late-onset pneumothorax, inadequate drainage, or subcutaneous position of one of the tube fenestrations. Diagnostic workup would include a chest CT study and bronchoscopy to rule out a bronchial leak, and then a therapeutic chest tube should be inserted in targeted fashion.
Reexpansion pulmonary edema
This is caused by too-rapid decompression of a pneumothorax or effusion that had been present for more than three days. To prevent this, it is recommended that the vacuum be built up slowly over several hours and that the tube be intermittently disconnected for a few minutes. Clinically, the observed symptoms range from cough to hemoptysis, but they are self-limiting.