Tube thoracostomy through an existing stab wound after refusal of conventional chest tube placement: a case report
Zubair Mohamed Dahir Sed, Badrudin A. WarsameIntroduction and importance:
Tube thoracostomy is the standard treatment for traumatic hemothorax requiring pleural drainage and is usually performed through the safe triangle. Rarely, management becomes challenging when a patient refuses the conventional insertion site. We report an unusual case of tube thoracostomy performed through an existing stab wound after the patient refused a separate chest tube incision.
Case presentation:
An 18-year-old, previously healthy male presented 6 hours after a right posterior lower chest stab injury. Chest radiography showed a moderate right-sided hemothorax. Tube thoracostomy was indicated because of reduced air entry and pleural fluid collection. The patient and his father declined the conventional insertion site after a discussion of risks and available options. After wound reassessment, confirmation of pleural communication, and informed consent, a 28-Fr chest tube was inserted through the existing stab wound under digital guidance. Approximately 300 mL of blood was drained immediately, with clinical improvement and no complications. The patient remained stable. Computed tomography imaging, which had initially been declined, was performed before discharge and demonstrated an AAST grade III posterior right hepatic laceration without active bleeding. The liver injury was managed non-operatively.
Clinical discussion:
The safe triangle remains the standard approach for tube thoracostomy. This case highlights the importance of careful assessment, patient autonomy, informed consent, and close observation when an unusual clinical situation requires individualized management.
Conclusion:
Tube thoracostomy through an existing stab wound should not replace the conventional technique. This single case does not establish the safety, efficacy, or reproducibility of this approach. However, in exceptional circumstances, it may be considered with caution, while maintaining patient safety and adhering to established surgical principles.