Life-saving emergency surgery due to delayed massive hemothorax 7 days after fall injury: a case report

Delayed hemothorax after thoracic trauma complicates approximately 7.4-36% of blunt traumas. Cases of delayed hemothorax that suddenly increase and require surgery are rare. We report a case of delayed massive hemothorax that was not relieved by vascular embolization but was successfully treated with surgery.

The patient was a 45-year-old man. He was rushed to the emergency room after falling from the 4th floor, and he underwent emergency surgery. The patient was weaned off the ventilator on postoperative day (POD) 3 but had bleeding of 500 ml/h from his left chest drain on POD 7. We initially performed intrathoracic angiography for the bleeding. Bleeding from the 9th and 10th intercostal arteries was confirmed. Although vascular embolization was performed, 6 h later, 500 ml/h of bleeding was observed again from the drain, and emergency surgery was performed. We performed ligation of the left 9th and 10th intercostal arteries and intrathoracic hematoma removal. The patient was weaned off the ventilator 14 days after the second surgery and was transferred for rehabilitation on day 50.

It is necessary to constantly monitor chest drainage and hemodynamics, especially within 7 days after injury, and to consider the possibility of emergency surgery.