A Case of Useful Intraoperative Autologous Transfusion for Traumatic Hemothorax due to Diaphragmatic Injury

Abstract

A 72-year-old man fell and bruised the right side of his back. The following day, he was referred to our hospital by ambulance with the chief complaint of dyspnea. Upon arrival, the patient had low blood pressure, and chest computed tomography showed multiple right rib fractures and a massive hemothorax ; he underwent emergency surgery. Thoracoscopy revealed a fracture of the 11^th rib, along with active bleeding from a transmural laceration of the right hemidiaphragm. We performed coagulation hemostasis via video-assisted thoracic surgery, directly sutured the injured hemidiaphragm, and repaired the fractured ribs. Total blood loss was 2,785 mL ; 2,585 mL blood was collected with autotransfusion devices, and 1,449 mL was returned to the patient. The patient was discharged 5 days after surgery. Intraoperative autologous transfusions can prevent potential complications of homologous blood transfusion and transmission of infection, and can be performed rapidly without cross-testing, even in emergency surgery. Conversely, the risk of infection is a concern when using autologous blood in trauma cases. However, in this case, the patient had a closed hemothorax, and the risk of infection was low ; thus, we used intraoperative autologous transfusions. Intraoperative autologous transfusions are useful for the treatment of traumatic hemothorax.