TITLE:
Management of Thoracoabdominal Wound with Damage to the Spleen and Diaphragm: A Case Report
AUTHORS:
Mamuka R. Gurgenidze, Giorgi A. Asatiani, Grigol S. Nemsadze, Aleks A. Chinchaladze, Giorgi G. Khulelidze
KEYWORDS:
Thoracoabdominal Wound, Diaphragm, Spleen
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.14 No.11,
November
18,
2025
ABSTRACT: Despite the extensive literature devoted to thoracoabdominal injuries of various origins, severity and nature, the management of patients with such injuries remains a challenge for surgeons of various specialties. Case Report: The patient was hospitalized at the First University Clinic of TSMU. He complained of multiple bleeding wounds on the chest and face. Stab wounds located in the following areas: 1) on the left mid-axillary line, in the IX-X intercostal space (2.5 cm × 1.5 cm); 2) on the left scapular line, at the level of the VII intercostal space (1.0 cm × 0.5 cm); 3) on the right paravertebral line, at the level of the VIII intercostal space (3.0 cm × 2.0 cm); 4) on the right scapular line, at the level of the IV intercostal space (2.0 cm × 1.0 cm). There is also a small stab wound on the mental area, on the left. All wounds were sutured with interrupted sutures. FAST was done immediately. Approximately 100 mL of fluid was detected in the left pleural cavity. Free fluid was detected as a narrow band in the left subdiaphragmatic region. A CT scan was performed. The mediastinum was not deviated. The heart was not enlarged. There was no free fluid or air in the mediastinum. On the left was a linear fracture of the VIII rib. A small effusion was visible in the left pleural cavity, with a separation of 0.9 cm. An inhomogeneous, increased-density area (hematoma) was seen at the anterior edge of the spleen. Against this, minor extravasation was observed. Free fluid was visible in the abdominal cavity, only adjacent to the spleen. There was no air. After 2.5 hours from the patient’s admission, during a control FAST study, the amount of fluid in the abdomen was increased and the patient was immediately taken to the operating room. Laparotomy, diaphragmorraphy, splenorrhaphy, small bowel repair (deserosation), washing and drainage of peritoneal cavity were performed. The patient was discharged from the clinic in an improved condition. The patient’s condition is good and he has no complaints. Thus, despite our efforts, we were unable to avoid open surgery, but even with such a complex injury as a penetrating thoracoabdominal wound, under certain circumstances, it is possible to use a watchful waiting approach, in some cases to use a minimally invasive intervention instead of a wide and traumatic laparotomy, and even to get by with active dynamic monitoring of the patient instead of routine drainage of the affected pleural cavity.