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1
MINIMAL INVASIVE SURGERY FOR RUPTURED DIAPHRAGM WITH OMENTAL HERNIATION, RUPTURED LUNG ABSCESS AND EMPYEMA
Moheb A. Rashid, MD, PhD,^1,2
1 Division of Vascular and Thoracic Surgery, Department of Surgery,
The Southern Norwegian Hospital of Kristiansand, Kristiansand, Norway.
² Scandinavian Cardiovascular Surgery Center, Gothenburg, Sweden.
BACKGROUND: The condition of ruptured lung abscess causing empyema associated with ruptured diaphragm and herniated omentum after blunt trauma is yet to be described in the literature, particularly when it is treated with a minimal invasive technique.
METHODS AND RESULTS: Herein, we present a minimal invasive procedure with case report. A 62-year-old man involved in a car accident 3 weeks before his admission with respiratory disturbances and sepsis. Computed tomography of the chest showed empyema, diaphragmatic rupture with abdominal herniation. He was operated on using an urgent limited left-sided posterolateal thoracotomy incision in the 7^th intercostal space. Through this incision, empyema was evacuated, the abdominal omentum and spleen were dissected free from the diaphragmatic defect (10 cm long) and replaced to the abdomen, the defect was repaired and total decortications of the left lung and evacuations of a ruptured huge lung abscess were performed. The operative and postoperative course was uneventful. The patient was doing well and came driving his motorcycle at 3 months follow-up.
CONCLUSIONS: We conclude that, the association of ruptured lung abscess causing empyema and ruptured diaphragm with herniated omentum after blunt trauma is yet to be known. A minimal invasive surgery was successful and it is suggested to be effective, and feasible technique in the treatment of critically ill patients with such a complex and rare entity.