Bush thoracotomy in the highlands of Papua New Guinea

Bush thoracotomy is a procedure performed by traditional medicine men to let out blood and pus from the chest. It has a significant complication rate and 60 cases presenting to the major hospital in Papua New Guinea are analysed over a 2-year period. The complications were empyema (40), osteomyelitis of the rib (2), wound infection (2), pneumothorax (1), neuralgia (1) and chest pain (4). All cases were further complicated by underlying pulmonary infection and often by delay in presentation. Fifteen cases were seen in the first year (1983-84) and forty-five in the second (1984-85). A more aggressive surgical approach was adopted in the second year (21 thoracotomies with 17 decortications compared with 1 thoracoplasty in the first year). However, this course of events was accompanied by an increase in mortality from 0 to 5. Although there were a number of contributory factors, lesser surgical procedures, such as open pleural drainage, are recommended for the sicker patients.