PMC5382907_01
1 - Knife penetrating the chest; 2- preoperative CT-scan; 3 - knife
removed; 4 - mediastinal view - the arrow shows omentum herniation
through the diaphragmatic injury; 5 - CorMatrix  patch closing
the diaphragmatic rupture.
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PMC5382907_01_rbccv-32-01-0057-g01.jpg
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On clinical examination, the patient had still the knife into his body (Figure 1-1) with whole blade inflicted just below the xiphoidal process, leaving outside only the knife handle. Pre-operative computed tomography (CT) scan showed critical proximity between the knife blade and the right ventricle (Figure 1-2) so suspecting a right ventricle injury arterial femoral cannulation for cardiopulmonary bypass was achieved. A median sternotomy was performed, the pericardium was longitudinally opened draining about of 500 ml of haematic fluid and the knife was safely removed (Figure 1-3). Intraoperative findings showed pericardial and diaphragmatic lesions with heart and abdominal organs integrity (Figure 1-4). CorMatrix  patch (Figure 1-5). Chest drain tubes were placed and the sternum was closed with interrupted steel wires.