<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2011-7582</journal-id>
<journal-title><![CDATA[Revista Colombiana de Cirugía]]></journal-title>
<abbrev-journal-title><![CDATA[rev. colomb. cir.]]></abbrev-journal-title>
<issn>2011-7582</issn>
<publisher>
<publisher-name><![CDATA[Asociación Colombiana de Cirugía]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2011-75822021000300540</article-id>
<article-id pub-id-type="doi">10.30944/20117582.711</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Challenging chest drainage: a case report]]></article-title>
<article-title xml:lang="es"><![CDATA[Drenaje torácico desafiante: reporte de un caso]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Medeiros]]></surname>
<given-names><![CDATA[Bruno José da Costa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Instituto de Cirurgia do Estado do Amazonas  ]]></institution>
<addr-line><![CDATA[Manaus ]]></addr-line>
<country>Brasil</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>09</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>09</month>
<year>2021</year>
</pub-date>
<volume>36</volume>
<numero>3</numero>
<fpage>540</fpage>
<lpage>544</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_arttext&amp;pid=S2011-75822021000300540&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_abstract&amp;pid=S2011-75822021000300540&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_pdf&amp;pid=S2011-75822021000300540&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction.  Chest trauma is one of the most common causes of death corresponding to 20 to 25 % of cases. The majority of the patients (85%), can be managed with only a tube thoracostomy. Our objective by presenting this case report is to provide an example of how to manage a challenging chest tube thoracostomy in a patient with cardiac hernia diagnosed in the preoperative phase, based on signs of computed tomography.  Case report.  A 45-year-old male presented to our emergency department who fell from a light pole 7 meters high. He fell to the ground on his back. Physical examination revealed a huge subcutaneous emphysema on his entire anterior chest wall and presented no sensitivity or movements below the navel line. After the initial assessment and management care, the patient improved. As the patient stabilized we decided to go to CT. The scan revealed pericardial rupture with only the right pericardial circumference intact, the heart herniated into the left pleural space, bilateral pneumothorax, small right hemothorax and a relevant subcutaneous emphysema surrounding the chest. We decided to perform the blunt dissection technique to insert chest tubes bilaterally because of safety. After performed it the patient was transferred to cardiothoracic department.  Discussion.  There is a variety of techniques to perform tube thoracostomy but the blunt dissection remain the safer, especially when we are facing an anatomic distortion of the heart.  Conclusion.  We present a case report of a challenging thoracic drainage performed in a patient with traumatic cardiac hernia, which procedure was successful.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción.  El traumatismo torácico es una de las causas más comunes de muerte y corresponde al 20 a 25 % de los casos. La mayoría de los pacientes (85 %) pueden tratarse solo con toracostomía. Nuestro objetivo al presentar este informe de caso es proporcionar un ejemplo de cómo manejar una toracostomía desafiante en un paciente con hernia cardíaca, diagnosticada en la fase preoperatoria, basada en signos de tomografía computarizada.  Presentación del caso.  Paciente masculino de 45 años que ingresa a nuestro departamento de emergencias luego de caída de 7 metros de altura (poste de luz), cayendo de espaldas al suelo. El examen físico reveló un enfisema subcutáneo importante en todo el tórax anterior y sin sensibilidad ni movimientos debajo de la línea del ombligo. Después de la evaluación y atención inicial el paciente mejoró y se decidió realizar una tomografía computarizada que reveló la rotura pericárdica, con solo la circunferencia pericárdica derecha intacta, el corazón herniado en el espacio pleural izquierdo, neumotórax bilateral, pequeño hemotórax en el lado derecho y enfisema subcutáneo rodeando completamente el tórax. Se escogió una técnica de disección roma para insertar el tubo torácico en ambos hemitórax, debido a su mayor seguridad. Posteriormente, el paciente fue trasladado al departamento de cirugía cardiotorácica.  Discusión.  Existe una variedad de técnicas para realizar una toracostomía con sonda, pero la disección roma sigue siendo la más segura, especialmente cuando enfrentamos una distorsión anatómica del corazón.  Conclusión.  Presentamos el caso de un drenaje torácico desafiante practicado a un paciente con hernia cardíaca traumática, con éxito.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[thoracic injuries]]></kwd>
<kwd lng="en"><![CDATA[wounds, nonpenetrating]]></kwd>
<kwd lng="en"><![CDATA[heart injuries]]></kwd>
<kwd lng="en"><![CDATA[myocardial contusions]]></kwd>
<kwd lng="en"><![CDATA[chest tube]]></kwd>
<kwd lng="en"><![CDATA[thoracostomy]]></kwd>
<kwd lng="es"><![CDATA[lesiones torácicas]]></kwd>
<kwd lng="es"><![CDATA[heridas no penetrantes]]></kwd>
<kwd lng="es"><![CDATA[lesiones cardíacas]]></kwd>
<kwd lng="es"><![CDATA[contusiones miocárdicas]]></kwd>
<kwd lng="es"><![CDATA[tubos de tórax]]></kwd>
<kwd lng="es"><![CDATA[toracostomía]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Carver]]></surname>
<given-names><![CDATA[DA]]></given-names>
</name>
<name>
<surname><![CDATA[Bressan]]></surname>
<given-names><![CDATA[AK]]></given-names>
</name>
<name>
<surname><![CDATA[Schieman]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Grondin]]></surname>
<given-names><![CDATA[SC]]></given-names>
</name>
<name>
<surname><![CDATA[Kirkpatrick]]></surname>
<given-names><![CDATA[AW]]></given-names>
</name>
<name>
<surname><![CDATA[Lall]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Management of haemothoraces in blunt thoracic trauma: study protocol for a randomised controlled]]></article-title>
<source><![CDATA[BMJ Open.]]></source>
<year>2018</year>
<volume>8</volume>
</nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mattox]]></surname>
<given-names><![CDATA[KL]]></given-names>
</name>
<name>
<surname><![CDATA[Wall]]></surname>
<given-names><![CDATA[MJ]]></given-names>
</name>
<name>
<surname><![CDATA[Tsai]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Trauma thoracotomy: principles and techniques]]></article-title>
<person-group person-group-type="editor">
<name>
<surname><![CDATA[Mattox KL]]></surname>
<given-names><![CDATA[editor]]></given-names>
</name>
<name>
<surname><![CDATA[Moore]]></surname>
<given-names><![CDATA[EE]]></given-names>
</name>
<name>
<surname><![CDATA[Feliciano]]></surname>
<given-names><![CDATA[DV]]></given-names>
</name>
</person-group>
<source><![CDATA[Trauma]]></source>
<year>2013</year>
<edition>7th edn</edition>
<page-range>461-7</page-range><publisher-loc><![CDATA[New York ]]></publisher-loc>
<publisher-name><![CDATA[McGraw-Hill]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lindenmann]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Matzi]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Neuboeck]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Porubsky]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Ratzenhofer]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Maier]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Smolle-Juettner]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Traumatic pericardial rupture with cardiac herniation]]></article-title>
<source><![CDATA[Ann Thorac Surg.]]></source>
<year>2010</year>
<volume>89</volume>
<page-range>2028-30</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mahmood]]></surname>
<given-names><![CDATA[K. Wahidi MM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Straghtening out chest tubes: what size, what type and when]]></article-title>
<source><![CDATA[Clin Chest Med.]]></source>
<year>2013</year>
<volume>34</volume>
<page-range>63-71</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Havelock]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Teoh]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Laws]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Gleeson]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<collab>BTS Disease Guideline Group</collab>
<article-title xml:lang=""><![CDATA[Pleural procedures and thoracic ultrasound: British thoracic Society pleural disease guideline 2010]]></article-title>
<source><![CDATA[Thorax.]]></source>
<year>2010</year>
<volume>65</volume>
<numero>^sSuppl 2</numero>
<issue>^sSuppl 2</issue>
<supplement>Suppl 2</supplement>
<page-range>ii61-76</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Fraser]]></surname>
<given-names><![CDATA[RS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Lung perforation complicating tube thoracostomy: pathologic description of three cases]]></article-title>
<source><![CDATA[Hum Pathol.]]></source>
<year>1988</year>
<volume>19</volume>
<page-range>518-23</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Meisel]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Ram]]></surname>
<given-names><![CDATA[Z]]></given-names>
</name>
<name>
<surname><![CDATA[Priel]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Nass]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Lieberman]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Another complication of thoracostomy -- perforation of the right atrium]]></article-title>
<source><![CDATA[Chest.]]></source>
<year>1990</year>
<volume>98</volume>
<page-range>772-3</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kopec]]></surname>
<given-names><![CDATA[SE]]></given-names>
</name>
<name>
<surname><![CDATA[Conlan]]></surname>
<given-names><![CDATA[AA]]></given-names>
</name>
<name>
<surname><![CDATA[Irwin]]></surname>
<given-names><![CDATA[RS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Perforation of the right ventricle: a complication of blind placement of a chest tube into the postpneumonectomy space]]></article-title>
<source><![CDATA[Chest.]]></source>
<year>1998</year>
<volume>114</volume>
<page-range>1213-5</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Al aseri]]></surname>
<given-names><![CDATA[Z]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Accuracy of chest radiograph interpretation by emergency physicians]]></article-title>
<source><![CDATA[Emerg Radiol.]]></source>
<year>2009</year>
<volume>16</volume>
<page-range>111-4</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kim]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Lim]]></surname>
<given-names><![CDATA[SH]]></given-names>
</name>
<name>
<surname><![CDATA[Seo]]></surname>
<given-names><![CDATA[PW]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Iatrogenic perforation of the left ventricule during insertion of a chest drain]]></article-title>
<source><![CDATA[Korean J Thorac Cardiovasc Surg.]]></source>
<year>2013</year>
<volume>46</volume>
<page-range>223-5</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Correa-Restrepo]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Restrepo-Moreno]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Peláez]]></surname>
<given-names><![CDATA[LG]]></given-names>
</name>
<name>
<surname><![CDATA[Díaz-Cadavid]]></surname>
<given-names><![CDATA[RD]]></given-names>
</name>
<name>
<surname><![CDATA[López-Vasco]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Rojas]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Radiografía de tórax de control en pacientes con neumotórax postraumático asintomático]]></article-title>
<source><![CDATA[Rev Colomb Cir.]]></source>
<year>2020</year>
<volume>35</volume>
<page-range>75-83</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kuhajda]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Zaragoulidis]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Kougioumtzi]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Huang]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[LI]]></surname>
<given-names><![CDATA[Q]]></given-names>
</name>
<name>
<surname><![CDATA[Dryllis]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Tube thoracostomy; chest tube implantation and follow up]]></article-title>
<source><![CDATA[J Thorac Dis.]]></source>
<year>2014</year>
<volume>6</volume>
<numero>^sSuppl 4</numero>
<issue>^sSuppl 4</issue>
<supplement>Suppl 4</supplement>
<page-range>S470-9</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="book">
<collab>American College of Surgeons (ACS) (United States)</collab>
<source><![CDATA[ATLS Advanced Trauma Life Support: student course manual]]></source>
<year>2018</year>
<edition>10.ed.</edition>
<publisher-loc><![CDATA[Chigago ]]></publisher-loc>
<publisher-name><![CDATA[The Committee On Trauma]]></publisher-name>
</nlm-citation>
</ref>
</ref-list>
</back>
</article>
