Damage COntrol Surgery in Precordial Injury with Massive Hemothorax and Cardiac Tamponade: A Case Report

Damage control surgery (DCS) is performed primarily as the management of critically injured patient who are an intergral part of resuscitation. Precordial injury with cardiac tamponade and massive hemothorax is the strong indication for DCS in term of live saving procedure. A 7-years-old girl was coming to the dr. Zainoel Abidin General Hospital (RSUZA) emergency room with precordial injuries after being shot with an airsoft gun. There is no unconsciousness with impairment of hemodynamics. There was a penetrated wound at the sternal notch, shortness of breath, dullness and decreased vesicular breath sound at the left hemithorax in the physical examination. Radiology examination showed enlargement of the antero-superior mediastinum, a foreign body at pericardial sac with a radio-opaque appearance at the left hemithorax. The patient was diagnosed with a precordial gunshot wound and cardiac tamponade accompanied by massive left hemothorax. Damage control surgery was performed with emergency sternotomy exploration, blood was found intra-pericard, the bullet injured the ascending aortic and penetrated the inferior lobe of the left lung. Bullet was evacuated followed by ascending aortic laceration was sutured and repaired of the inferior lobe of the left lung. Patient was discharged on the 5 th day afterwards with a good result. Precordial injuries patient is at primary risk for chest trauma related complication and death. Effective and timely surgical intervention as well as damage control surgery is critical to favorable outcomes.