[Postoperative Intrathoracic Hemorrhage;Perioperative Prevention and Management]

Postoperative intrathoracic hemorrhage is sometimes diagnosed in the thoracic cavity, while the patient is in the recovery room after undergoing thoracic surgery such as lung resection with thoracotomy or mediastinal surgery with a median sternotomy. The information from the chest tube is important to identify this kind of postoperative complication. When the condition becomes severe, the patient may develop hemorrhagic shock due to hemothorax and re-exploration to assess for bleeding and hemostasis may be required. The frequency of reoperation required in patients with postoperative hemorrhage is considered to be 1~3%. The bronchial artery, intercostal artery, and the intercostal vein are the most frequent sources of the hemorrhage. In some cases, the source of hemorrhage cannot be identified during re-exploration. However, intrathoracic hematoma removal by reoperation is essential to allow for adequate expansion of the remaining lung. Although a thoracoscope is usually inserted for re-exploration of the thoracic cavity initially, quick thoracotomy might be required to control hemorrhage, if the patient's vitals indicate rapid hemorrhage and subsequent shock.