Post-traumatic liver injury caused by chest tube placement: myths and controversies in conservative management

This case report describes the conservative management of an iatrogenic hepatic injury secondary to chest tube thoracostomy in a 54-year-old male with severe thoracic polytrauma. A right-sided chest tube inserted in the seventh intercostal space for hemothorax resulted in transhepatic malposition. Given hemodynamic stability and absence of active hemorrhage, non-operative management (device removal and primary suture) was undertaken with strict monitoring and favorable evolution. This case underscores the feasibility of conservative management in selected patients and cautions against automatic classification as impalement trauma requiring laparotomy.