2020 Volume 34 Issue 5 Pages 327-333
An 83-year-old man fell and hit his left chest hard on the day of hospitalization for the treatment of pneumonia. Chest drainage was performed since computed tomography (CT) revealed a fracture of the left ninth rib and pneumothorax. The drained discharge became turbid and with the diagnosis of acute empyema, the patient was transferred to our hospital. Thoracoscopic decortication followed by open window thoracotomy was performed; however, the discharge continued. Contrast-enhanced CT revealed a fistula between the thoracic cavity and transverse colon via the diaphragm. The fistula was located on the diaphragm close to the costophrenic recess. A tube was inserted through the fistula and double barrel transverse colostomy was performed. Thereafter, the infection in the thoracic cavity reduced promptly and the pyothorax spontaneously improved. Diaphragmatic injury due to rib fractures can cause hemothorax and diaphragmatic hernia, but the ends of fractured bones usually do not penetrate the diaphragm or intestine. This patient had a history of surgery for gastric cancer, and it was suspected that the acute empyema was caused by penetration of the fractured rib end into the transverse colon because the transverse colon had adhered to the left diaphragm.
