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Pleurocutaneous Fistulas of Fecopneumothorax: Unusual Complications of Penetrating Thoracic Trauma Due to Zebu Gord

Narindra Njarasoa Mihaja Razafimanjato, Odilon Guillaume Tsiambanizafy, Tsiry Dama Ntsoa Ravelomihary, Manjakaniaina Ravoatrarilandy, Auberlin Felantsoa Rakototitana, Hanitrala Jean Louis Rakotovao.

Abstract
Introduction: Our case highlights an extremely rare colopleural fistula in the setting of post-traumatic diaphragmatic hernia following penetrating wound thoracic of zebu gord with delayed presentation, suspected clinic-radiologically and confirmed on surgery.
Case presentation: A 60-year old moribund male with three months history of open-chest penetrating due to zebu gord, came to the emergency department with a clinical presentation of sepsis syndrome and a deterioration of the general status. On examination, the patient cachectic presented a fecopurulent liquid drainage from an orifice in the anterolateral region of left hemithorax with necrotizing fasciitis. A chest X-ray showed uncompressing hydropneumothorax in the left pleural cavity.
Conclusion: The patient we report had the most serious complications of post-traumatic diaphragmatic hernia, fecopneumothorax, pleurocutaneous fistula, and necrotizing fasciitis. An emergency laparotomy was carried out. The problem was successfully treated by colon resection anastomosis, pleurectomy, and negative pressure therapy.

Key words: Fistula, diaphragm, fecopneumothorax, pleurocutaneous fistula, intestinal perforation, Sister Leena's sign, thoracostomy, traumatic diaphragmatic hernia



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