Stable Penetrating Chest Trauma

Annotation for Point H

Diaphragmatic injury may be suspected by location of the wound, path of the missile, or clinical findings. Left thoracoabdominal wounds have up to 17% incidence of diaphragmatic penetration.⁴⁴ When diaphragm injury is suspected but there are no clinical or other findings that mandate laparotomy or thoracotomy, laparoscopy and thoracoscopy are both reasonable options.⁴⁴ In patients with pneumothorax or retained hemothorax, thoracoscopy is a reasonable option. Left diaphragm injuries mandate abdominal exploration. Right-sided injuries, in stable patients, when it is felt that there is only an injury to the liver that does not require operation, do not always mandate abdominal exploration.⁴⁵ The diaphragmatic injury itself can be repaired thoracoscopically or by thoracotomy, depending on surgeon’s preference, or can be followed up to see if repair is needed at all. Repairs via laparoscopy or laparotomy are also acceptable approaches.