Abstract
A 50-year-old man was admitted to our hospital because of blunt right chest injury due to falling down in July 2003. Twelve days after the injury he was diagnosed with right hemothorax and underwent chest drainage from the right 7th intercostal space on the middle axillary line. After chest drainage, computed tomography (CT) scan revealed many residual blood clots in the thoracic cavity. The patient underwent video-assisted thoracic surgery (VATS) to evacuate and treat the blood clots in the thoracic cavity 16 days after the injury. The initial port was approached from the route of the preoperatively inserted chest tube to avoid injuring the lung; however, the trocar was inserted into the abdominal cavity through the diaphragm, which was adhered to the chest wall. There was no organ injury in the abdominal cavity at the time of trocar entry. We approached from the 5th intercostal space of the dorsum, to which the lung was not adhered on CT scan, and could reach the pleural cavity appropriately. Then, blood clot evacuation, decortication and ablation were performed by VATS and the injured diaphragm was repaired by direct suturing with minithoracotomy. The patient had an uneventful postoperative recovery. In cases of lung adhesion in the thoracic cavity, the initial port for a VATS procedure should be approached through a position different from the preoperatively inserted chest tube, when there is the possibility of diaphragm injury.
