Chest Tube Malpositioning-related Hemothorax and Intra-abdominal Bleeding-A Case Report

胸管誤置引起血胸及腹腔內出血－病例報告

徐博奎(Po-Kuei Hsu) ； 王鑑瀛(Chien-Ying Wang) ； 黃睦舜(Mu-Shun Huang)

《胸腔醫學》 21卷6期 (2006/12) Pp. 524-528

https://doi.org/10.29806/TM.200612.0007

摘要

插胸管是在急診室及胸腔科病房常施行的處置，用以處理助膜腔不正常的空氣或液體積留，胸管誤置雖不少見，卻可能對病人造成極大併發症。我們報告一位44歲男性，因騎機車車禍送到急診室，由於皮下氣腫，便在懷疑氣胸的存在下快速插上胸管，因爲血壓不穩及持續有鮮血引流，於是病人被轉往本院。胸部X光懷疑胸管誤置，外傷重點腹部超音波可見血胸及腹內積水，爲評估腹內狀況，安排電腦斷層檢查，結果證實胸管誤插至肝臟之中，緊急拔除誤置的胸管並重新插入胸管。病人經保守治療11天後拔除胸管，肺部復原良好。常用插胸管的方式包括套管穿刺法及手指剝離法，前法雖然較為簡單方便，但在緊急狀況，嚴重皮下氣腫及病人無法正確配合時，我們建議使用手指剝離法較爲安全。

關鍵字

胸管 ； 併發症 ； 血胸 ； 腹內出血

並列摘要

Chest tube insertion is a standard procedure for pneumothorax, massive hemothorax, and hemopneumothorax in emergency departments. The 2 common techniques used for the insertion of chest tubes are the trocar method and blunt dissection. Although the trocar method is simpler, it is associated with a higher incidence of complications. In contrast, blunt dissection is safer and minimizes trauma to neurovascular bundles. The complications of chest tube insertion include infection, tube malpositioning, and injury to internal organs. Inadvertent malpositioning of chest tubes may cause unnecessary trauma to patients. We report a complication due to chest tube malpositioning.
Computed tomography disclosed an intra-hepatically malpositioned chest tube in a patient who had undergone thoracostomy for right-side hemopneumothorax, with a continuous drainage of blood from the chest tube and hemodynamic instability. Tube thoracostomy-related hemothorax and intra-abdominal bleeding were suspected. Immediate removal of the chest tube and insertion of a new chest tube were performed. The hemopneumothorax condition stabilized after conservative management and the chest tube was removed 11 days later. Complications of tube thoracostomy are reviewed in this report.

並列關鍵字

chest tube ； complication ； hemothorax ； internal bleeding