A place that is easier to get into than to get out of!

Excerpt

Abdominal visceral injuries secondary to chest tube misplacement are associated with significant morbidity. We report the case of a 41-yr-old morbidly obese (body mass index 45 kg·m⁻²) woman who was admitted to our intensive care unit (ICU) three weeks after sleeve gastrectomy. She exhibited respiratory distress and signs of sepsis. Chest radiography followed by thoracic ultrasonography (US) revealed a pleural empyema. A left chest tube placed in the ICU with the assistance of a nurse was used to retract excessive lateral thoracic wall adipose tissue. Because of poor-quality US imaging, the chest tube was placed without imaging, using an integrated metal trocar to guide it through the overlying adipose tissue and into the pleural space (20 cm marking at the skin) without apparent resistance. As no pleural fluid was noted in the chest tube, however, the procedure was stopped, and a chest radiograph was obtained. The radiograph suggested an abdominal location of the chest tube, so computed tomography (CT) was performed. Coronal CT reconstruction confirmed the abnormal course of the tube, which had been passed into the splenic parenchyma. …