Pub Date : 2018-11-30DOI: 10.24184/TIP.2018.3.2.62
C. Park, Wu-Seong Kang, S. Seo, S. Moon
A 67-year-old male presented to the emergency department with left neck pain and swelling after meeting with a traffic accident. The neck computed tomography (CT) revealed a multifocal contrast media extravasation from the left internal jugular vein (IJV) and a severe mass affecting the diffuse soft tissue infiltrating and thickening the deep cervical and superficial cervical spaces (Fig. 1). The left cervical portion was compressed with a sand bag (Fig. 2). The patency of both IJV was confirmed in the neck ultrasound on the following morning (Fig. 3). One week later, follow-up CT revealed total recanalization of the occluded left IJV, marked absorption of preexisting hematoma located in the deep neck spaces, and a bulging caused by liquefaction of the resolving hematoma in the left masticator and posterior cervical space (Fig. 4). The left IJV, not found in threedimensional angiographic images in the neck CT, was observed again after 1 week (Fig. 5).
{"title":"Nonsurgical Management of Traumatic Internal Jugular Vein Rupture Using Direct Compression","authors":"C. Park, Wu-Seong Kang, S. Seo, S. Moon","doi":"10.24184/TIP.2018.3.2.62","DOIUrl":"https://doi.org/10.24184/TIP.2018.3.2.62","url":null,"abstract":"A 67-year-old male presented to the emergency department with left neck pain and swelling after meeting with a traffic accident. The neck computed tomography (CT) revealed a multifocal contrast media extravasation from the left internal jugular vein (IJV) and a severe mass affecting the diffuse soft tissue infiltrating and thickening the deep cervical and superficial cervical spaces (Fig. 1). The left cervical portion was compressed with a sand bag (Fig. 2). The patency of both IJV was confirmed in the neck ultrasound on the following morning (Fig. 3). One week later, follow-up CT revealed total recanalization of the occluded left IJV, marked absorption of preexisting hematoma located in the deep neck spaces, and a bulging caused by liquefaction of the resolving hematoma in the left masticator and posterior cervical space (Fig. 4). The left IJV, not found in threedimensional angiographic images in the neck CT, was observed again after 1 week (Fig. 5).","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124640719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-05-31DOI: 10.24184/TIP.2018.3.1.14
D. H. Kim, Ye Rim Chang, Jung-Ho Yun
A 51-year-old male was admitted to the emergency room after a traffic accident. He was a carrier of hepatitis B and had liver cirrhosis of Child Pugh classification A. Upon arrival, he was stupor with multiple laceration of the scalp and face and a belt sign on the abdomen. Physical examination revealed no peritoneal irritation signs or abdominal distension. Initial computed tomography (CT) of the abdomen revealed no definite intraabdominal organ injury, except for stomach distension with the presence of intraluminal fluid (Fig. 1.). He underwent an emergency craniotomy for traumatic epidural hematoma with stable hemodynamics. His injury severity score was 38. During intensive care, massive hematochezia was presented with hypotension, and a hemoglobin level of 6.7 g/dL was observed at 11 h after the operation. In addition, esophagogastroduodenal endoscopy revealed multiple mucosal lacerations on cardia, with active bleeding and no varices (Fig. 2.). Because his hemodynamics were stabilized with response to massive transfusion (red blood cell, 16 units; fresh frozen plasma, 13 units; platelet, 16 units), he was conservatively treated with a proton pump inhibitor, antithrombin III, and tranexamic acid, and finally progressed to full recovery.
{"title":"Intraluminal Stomach Injury after Blunt Trauma","authors":"D. H. Kim, Ye Rim Chang, Jung-Ho Yun","doi":"10.24184/TIP.2018.3.1.14","DOIUrl":"https://doi.org/10.24184/TIP.2018.3.1.14","url":null,"abstract":"A 51-year-old male was admitted to the emergency room after a traffic accident. He was a carrier of hepatitis B and had liver cirrhosis of Child Pugh classification A. Upon arrival, he was stupor with multiple laceration of the scalp and face and a belt sign on the abdomen. Physical examination revealed no peritoneal irritation signs or abdominal distension. Initial computed tomography (CT) of the abdomen revealed no definite intraabdominal organ injury, except for stomach distension with the presence of intraluminal fluid (Fig. 1.). He underwent an emergency craniotomy for traumatic epidural hematoma with stable hemodynamics. His injury severity score was 38. During intensive care, massive hematochezia was presented with hypotension, and a hemoglobin level of 6.7 g/dL was observed at 11 h after the operation. In addition, esophagogastroduodenal endoscopy revealed multiple mucosal lacerations on cardia, with active bleeding and no varices (Fig. 2.). Because his hemodynamics were stabilized with response to massive transfusion (red blood cell, 16 units; fresh frozen plasma, 13 units; platelet, 16 units), he was conservatively treated with a proton pump inhibitor, antithrombin III, and tranexamic acid, and finally progressed to full recovery.","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"106 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114070770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-05-31DOI: 10.24184/TIP.2018.3.1.20
C. Park, H. Cho, Hoon Kwon, C. Jeon, C. Kim
A 60-year-old male presented to the emergency department at midnight through referral by another hospital, where he underwent transcatheter arterial embolization (TAE) for pelvic bleeding that developed after falling from a height of 9 m. The patient’s vital signs were as follows: systolic blood pressure, 70 mm Hg; pulse rate, 128 beats/min; respiration rate, 40 breaths/min; body temperature, 36.3°C; and oxygen saturation, 89%. Accordingly, immediate intubation and mechanical ventilation were performed. His initial arterial blood gas analysis (ABGA) revealed a pH of 6.99, HCO3− of 10.8, lactic acid profile of 13.5 mmol/L, and a base excess of −19.6. Abdominal CT after fluid resuscitation demonstrated an unstable pelvic ring fracture (Fig. 1.). The patient was therefore suspected of hemorrhagic shock caused by persistent bleeding from the blood vessels in the pelvis. Therefore, we decided to perform TAE for hemorrhage control. Priming of the continuous renal replacement therapy (CRRT) was conducted during the interventional radiologist’s visit to the hospital. A catheter was inserted via the left femoral vein in the intervention room immediately before Treatment Progression in Trauma eISSN: 2508-8033 pISSN: 2508-5298
一名60岁男性于午夜通过另一家医院的转诊来到急诊室，因从9米高处坠落后出现盆腔出血，接受了经导管动脉栓塞术(TAE)。患者生命体征如下:收缩压70 mm Hg;脉搏率:128次/分;呼吸频率:40次/分;体温:36.3℃;氧饱和度，89%。因此，立即插管和机械通气。他最初的动脉血气分析(ABGA)显示pH为6.99,HCO3 -为10.8，乳酸谱为13.5 mmol/L，碱过量为- 19.6。液体复苏后腹部CT显示不稳定骨盆环骨折(图1)。因此，该患者被怀疑是骨盆血管持续出血引起的失血性休克。因此，我们决定行TAE来控制出血。持续肾替代治疗(CRRT)的启动是在介入放射科医生访问医院期间进行的。在创伤治疗进展前立即在干预室通过左股静脉插入导管eISSN: 2508-8033 pISSN: 2508-5298
{"title":"CRRT during TAE in Unstable Pelvic Fracture with Severe Lactic Acidosis","authors":"C. Park, H. Cho, Hoon Kwon, C. Jeon, C. Kim","doi":"10.24184/TIP.2018.3.1.20","DOIUrl":"https://doi.org/10.24184/TIP.2018.3.1.20","url":null,"abstract":"A 60-year-old male presented to the emergency department at midnight through referral by another hospital, where he underwent transcatheter arterial embolization (TAE) for pelvic bleeding that developed after falling from a height of 9 m. The patient’s vital signs were as follows: systolic blood pressure, 70 mm Hg; pulse rate, 128 beats/min; respiration rate, 40 breaths/min; body temperature, 36.3°C; and oxygen saturation, 89%. Accordingly, immediate intubation and mechanical ventilation were performed. His initial arterial blood gas analysis (ABGA) revealed a pH of 6.99, HCO3− of 10.8, lactic acid profile of 13.5 mmol/L, and a base excess of −19.6. Abdominal CT after fluid resuscitation demonstrated an unstable pelvic ring fracture (Fig. 1.). The patient was therefore suspected of hemorrhagic shock caused by persistent bleeding from the blood vessels in the pelvis. Therefore, we decided to perform TAE for hemorrhage control. Priming of the continuous renal replacement therapy (CRRT) was conducted during the interventional radiologist’s visit to the hospital. A catheter was inserted via the left femoral vein in the intervention room immediately before Treatment Progression in Trauma eISSN: 2508-8033 pISSN: 2508-5298","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133362414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Two females aged 67 and 29 years were admitted with comatose mentality and sustained blunt trauma from a traffic accident and a fall, respectively. Both patients had a cardiac arrest at the accident scene, and return of spontaneous circulation was achieved after cardiopulmonary resuscitation. The injury severity scores were 38 and 75, respectively, without massive bleeding focus. Upon arrival at the hospital, the initial hemodynamics of both the patients were unstable with a pulse rate of 128 and 80 beats/min and a blood pressure of 79/64 and 39/22 mm Hg, respectively. The first patient was subjected to resuscitative endovascular balloon occlusion of the aorta in the emergency room before checking for trauma series; however, her blood pressure was temporarily elevated and then decreased despite administering high-dose vasopressor infusion. The hemodynamics of the second patient was constantly aggravated with high-dose vasopressor infusion. Subsequently, both patients died in 90 and 56 min, respectively, after their arrivals. The cross-table lateral radiograph of the cervical spine of both the patients showed atlanto-occipital dislocation (AOD) (Figs. 1 and 2.).
{"title":"Traumatic Atlanto-Occipital Dislocation: Two Cases","authors":"D. H. Kim, Jung-Ho Yun","doi":"10.24184/TIP.2018.3.1.5","DOIUrl":"https://doi.org/10.24184/TIP.2018.3.1.5","url":null,"abstract":"Two females aged 67 and 29 years were admitted with comatose mentality and sustained blunt trauma from a traffic accident and a fall, respectively. Both patients had a cardiac arrest at the accident scene, and return of spontaneous circulation was achieved after cardiopulmonary resuscitation. The injury severity scores were 38 and 75, respectively, without massive bleeding focus. Upon arrival at the hospital, the initial hemodynamics of both the patients were unstable with a pulse rate of 128 and 80 beats/min and a blood pressure of 79/64 and 39/22 mm Hg, respectively. The first patient was subjected to resuscitative endovascular balloon occlusion of the aorta in the emergency room before checking for trauma series; however, her blood pressure was temporarily elevated and then decreased despite administering high-dose vasopressor infusion. The hemodynamics of the second patient was constantly aggravated with high-dose vasopressor infusion. Subsequently, both patients died in 90 and 56 min, respectively, after their arrivals. The cross-table lateral radiograph of the cervical spine of both the patients showed atlanto-occipital dislocation (AOD) (Figs. 1 and 2.).","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"367 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114783371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Penetrating Neck Injury Evolving into Thyroid Injury with Empty Cartridge","authors":"P. Y. Jung","doi":"10.24184/TIP.2018.3.1.3","DOIUrl":"https://doi.org/10.24184/TIP.2018.3.1.3","url":null,"abstract":"","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131930142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-05-31DOI: 10.24184/TIP.2018.3.1.30
Sung Jin Kim, D. Ma
A 34-year-old male struck by a steel ball was transferred to our trauma center. He suffered from a right ulnar fracture and a right femoral degloving injury sized approximately 20 × 30 cm, with a contaminated wound (Fig. 1-1.). After adequate debridement and irrigation, defatting with scalpels and the VERSAJET system (Smith and Nehew) was performed, followed by multiple small incisions for drainage of full-thickness skin graft to cover the denuded area (Fig. 1-2.). Negative-pressure wound therapy as applied after covering with Bactigras (Smith and Nehew). After 3 days, large necrotic areas were observed (Fig. 1-3.). At postoperative day 9, debridement and STSG were performed. At the 20-days follow-up postoperatively, the appearance had reduced to an acceptable level (Fig. 1-4). CASE II
一名34岁男性被钢球击中被转移到我们的创伤中心。患者右尺骨折，右股脱手套损伤，尺寸约为20 × 30 cm，伤口受污染(图1-1)。在充分清创和冲洗后，使用手术刀和VERSAJET系统(Smith and Nehew)进行去脂，然后进行多个小切口引流全层皮肤移植物以覆盖剥落区域(图1-2)。负压伤口治疗应用后覆盖Bactigras(史密斯和Nehew)。3天后，观察到大面积坏死区域(图1-3)。术后第9天，行清创和STSG。术后20天随访，外观降至可接受水平(图1-4)。案例二世
{"title":"Soft Tissue Management of Degloving Wounds: Two Cases","authors":"Sung Jin Kim, D. Ma","doi":"10.24184/TIP.2018.3.1.30","DOIUrl":"https://doi.org/10.24184/TIP.2018.3.1.30","url":null,"abstract":"A 34-year-old male struck by a steel ball was transferred to our trauma center. He suffered from a right ulnar fracture and a right femoral degloving injury sized approximately 20 × 30 cm, with a contaminated wound (Fig. 1-1.). After adequate debridement and irrigation, defatting with scalpels and the VERSAJET system (Smith and Nehew) was performed, followed by multiple small incisions for drainage of full-thickness skin graft to cover the denuded area (Fig. 1-2.). Negative-pressure wound therapy as applied after covering with Bactigras (Smith and Nehew). After 3 days, large necrotic areas were observed (Fig. 1-3.). At postoperative day 9, debridement and STSG were performed. At the 20-days follow-up postoperatively, the appearance had reduced to an acceptable level (Fig. 1-4). CASE II","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133116469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-05-31DOI: 10.24184/TIP.2018.3.1.23
P. Y. Jung, K. Kwon
A 79-year-old male with no medical history was admitted to the emergency room with multiple shotgun injuries. He was mistakenly shot by a hunter hunting for a water deer. Upon admission, the patient was hemodynamically stable, but showed multiple shotgun injuries on the head, chest, abdomen, forearm, and leg (Fig. 1.). Further, he had hemoperitoneum and peritonitis because of bowel perforation and a mesentery injury. We accordingly planned for an emergency abdominal surgery followed by an orthopedic surgery (Fig. 2.). We employed C-Arm fluoroscopy to accurately locate the bullets in his body and to check for any remaining bullets. All bullets were removed using C-Arm fluoroscopy (Fig. 3.). The patient recovered without any complications. DISCUSSION
{"title":"Usefulness of C-Arm Fluoroscopy in Treating Patients Injured by a Shotgun","authors":"P. Y. Jung, K. Kwon","doi":"10.24184/TIP.2018.3.1.23","DOIUrl":"https://doi.org/10.24184/TIP.2018.3.1.23","url":null,"abstract":"A 79-year-old male with no medical history was admitted to the emergency room with multiple shotgun injuries. He was mistakenly shot by a hunter hunting for a water deer. Upon admission, the patient was hemodynamically stable, but showed multiple shotgun injuries on the head, chest, abdomen, forearm, and leg (Fig. 1.). Further, he had hemoperitoneum and peritonitis because of bowel perforation and a mesentery injury. We accordingly planned for an emergency abdominal surgery followed by an orthopedic surgery (Fig. 2.). We employed C-Arm fluoroscopy to accurately locate the bullets in his body and to check for any remaining bullets. All bullets were removed using C-Arm fluoroscopy (Fig. 3.). The patient recovered without any complications. DISCUSSION","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133927828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-05-31DOI: 10.24184/TIP.2018.3.1.11
Jin Young Lee, S. J. Go, Y. Sul, J. Ye, S. Yoon, Hong Rye Kim, Mou-Seop Lee, J. Choi, D. Ryu
A 29-year-old male presented to our emergency department with a penetrating torso injury caused by a sharp and long steel bar. The patient slipped on a big straw pile and was struck on a protruding steel bar. The bar penetrated upward from the right flank to the middle portion of his right chest, and the rest of it was exposed toward his right foot. However, the patient only complained of pain at the right flank, and his vital signs were as follows: blood pressure, 120/70 mm Hg; pulse rate, 74 beats/min; respiratory rate, 26 breaths/min; body temperature, 37.2°C; and oxygen saturation, 98%. His arterial blood gas analysis revealed a pH of 7.38, pCO2 level of 38 mm Hg, pO2 level of 86.3 mmHg, and SaO2 level of 98%. The patient’s chest X-ray did not show any thoracic Fig. 1. Chest AP showing the tip of the steel bar in the right chest area without any hemothorax and pneumothorax Brief Image in Trauma eISSN: 2508-8033 pISSN: 2508-5298
一名29岁男性因被一根锋利的长钢筋刺伤躯干而来到我们的急诊科。病人在一大堆稻草堆上滑倒，被一根突出的钢筋击中。那根杠从右腹向上刺进他的右胸中部，其余部分露出他的右脚。但患者仅主诉右侧疼痛，生命体征如下:血压，120/70 mm Hg;脉搏:74次/分;呼吸频率:26次/分;体温:37.2℃;氧饱和度，98%。他的动脉血气分析显示pH值为7.38,pCO2水平为38毫米汞柱，pO2水平为86.3毫米汞柱，SaO2水平为98%。患者胸片未见任何胸部图1。胸部AP显示右侧胸区钢筋尖端，无血胸和气胸。创伤学简图eISSN: 2508-8033 pISSN: 2508-5298
{"title":"Penetrating Torso Injury Cause by a Steel Bar","authors":"Jin Young Lee, S. J. Go, Y. Sul, J. Ye, S. Yoon, Hong Rye Kim, Mou-Seop Lee, J. Choi, D. Ryu","doi":"10.24184/TIP.2018.3.1.11","DOIUrl":"https://doi.org/10.24184/TIP.2018.3.1.11","url":null,"abstract":"A 29-year-old male presented to our emergency department with a penetrating torso injury caused by a sharp and long steel bar. The patient slipped on a big straw pile and was struck on a protruding steel bar. The bar penetrated upward from the right flank to the middle portion of his right chest, and the rest of it was exposed toward his right foot. However, the patient only complained of pain at the right flank, and his vital signs were as follows: blood pressure, 120/70 mm Hg; pulse rate, 74 beats/min; respiratory rate, 26 breaths/min; body temperature, 37.2°C; and oxygen saturation, 98%. His arterial blood gas analysis revealed a pH of 7.38, pCO2 level of 38 mm Hg, pO2 level of 86.3 mmHg, and SaO2 level of 98%. The patient’s chest X-ray did not show any thoracic Fig. 1. Chest AP showing the tip of the steel bar in the right chest area without any hemothorax and pneumothorax Brief Image in Trauma eISSN: 2508-8033 pISSN: 2508-5298","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121913124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-05-31DOI: 10.24184/TIP.2018.3.1.25
D. H. Kim
A 40-year-old male was admitted with penetrating and blunt injury to his right thoracoabdominal area caused by a crushing accident at his workplace (Fig. 1.). Upon admission, he was alert with a blood pressure of 135/81 mm Hg, pulse rate of 109 beats/min, respiratory rate of 40/min, and hemoglobin level of 8.5 g/dL. Physical examination revealed peritoneal irritation signs on the whole abdomen. A focused assessment with sonography for trauma revealed large amounts of intra-abdominal fluid collection in the Morison pouch and splenorenal recess. Computed tomography performed in response to resuscitation demonstrated a right hepatic injury and a right diaphragm rupture with herniation of the colon (Fig. 2.). He underwent emergency laparotomy, including primary repair of the right diaphragm, perihepatic packing, and temporary abdominal closure, with an operation time of 84 min (Video 1.). After the damage control surgery, a lethal triad with a pH of 7.26, lactate level of 4.3 mmol/L, international normalized ratio of 2.40, and a temperature of 35.1°C occurred and was corrected after resuscitation of transfusion and warming in the intensive care unit (ICU). Definitive surgery, including right hemihepatectomy and definitive abdominal closure, was performed 12 h after the first operation (Video 2.). The patient was discharged without any complications 20 days after the definitive surgery.
一名40岁男性因工作场所挤压事故导致右胸腹区钝性穿透伤入院(图1)。入院时，患者血压135/81 mm Hg，脉搏109次/分，呼吸频率40次/分，血红蛋白水平8.5 g/dL。体格检查发现整个腹部有腹膜刺激征象。超声对创伤的集中评估显示大量腹腔内积液在Morison袋和脾肾隐窝。复苏后进行的计算机断层扫描显示右肝损伤和右膈破裂伴结肠疝(图2)。他接受了紧急剖腹手术，包括初步修复右膈、肝周填塞和暂时关闭腹部，手术时间为84分钟(视频1)。术后发生致死性三联征，pH值7.26，乳酸水平4.3 mmol/L，国际标准化比值2.40，体温35.1℃，经输血加温复苏纠正。首次手术后12小时进行最终手术，包括右半肝切除术和最终腹部关闭术(视频2)。患者在最终手术后20天无任何并发症出院。
{"title":"Right Hemihepatectomy after Damage control Surgery for High-grade Hepatic Injury with Diaphragm Rupture","authors":"D. H. Kim","doi":"10.24184/TIP.2018.3.1.25","DOIUrl":"https://doi.org/10.24184/TIP.2018.3.1.25","url":null,"abstract":"A 40-year-old male was admitted with penetrating and blunt injury to his right thoracoabdominal area caused by a crushing accident at his workplace (Fig. 1.). Upon admission, he was alert with a blood pressure of 135/81 mm Hg, pulse rate of 109 beats/min, respiratory rate of 40/min, and hemoglobin level of 8.5 g/dL. Physical examination revealed peritoneal irritation signs on the whole abdomen. A focused assessment with sonography for trauma revealed large amounts of intra-abdominal fluid collection in the Morison pouch and splenorenal recess. Computed tomography performed in response to resuscitation demonstrated a right hepatic injury and a right diaphragm rupture with herniation of the colon (Fig. 2.). He underwent emergency laparotomy, including primary repair of the right diaphragm, perihepatic packing, and temporary abdominal closure, with an operation time of 84 min (Video 1.). After the damage control surgery, a lethal triad with a pH of 7.26, lactate level of 4.3 mmol/L, international normalized ratio of 2.40, and a temperature of 35.1°C occurred and was corrected after resuscitation of transfusion and warming in the intensive care unit (ICU). Definitive surgery, including right hemihepatectomy and definitive abdominal closure, was performed 12 h after the first operation (Video 2.). The patient was discharged without any complications 20 days after the definitive surgery.","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130190684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-05-31DOI: 10.24184/TIP.2018.3.1.17
Ho Hyoung Lee, Joongsuck Kim, Min Koo Lee, Kyounghwan Kim, Sung Ho Han, S. Chon, O. Kwon
A 36-year-old female participated in paragliding during a visit to Jeju island. Due to a rogue wind gust, her and pilot crashed into a high voltage (22000 V) electrical wire. Her ankle was hung from the electrical wire. The pilot was in cardiac arrest upon arrival of emergency personnel at the scene. Her initial vital signs were 128/81mmHg-121/min-20/min-37.8°C, and her EKG was nonspecific. She complained of severe pain in her left-side extremities. We found a severe burn (grade III-IV) on her left upper and lower extremities (Fig. 1.). We inserted a right subclavian central catheter and an additional internal jugular hemo-catheter for vigorous hydration and preparation of hemodialysis. Traumatologists performed an escharotomy on her upper and lower extremities and called for an orthopedic surgeon. The traumatologist and orthopedic doctor elected to perform an emergency operation (fasciotomy of the left upper limb and above-knee amputation of the left lower limb). Her initial urine myoglobulin level was 1923 mcg/L. After resuscitation, she was sent to the operation room. One orthopedic doctor and two traumatologists performed an above-knee amputation and fasciotomy, simultaneously (Fig. 2.). For pain control and facilitation of further operational procedures, we kept the patient ventilated and under continuous infusion of sedatives and analgesics. After the first operation, we consulted a nephrologist and applied renal replacement therapy to her. We debrided and irrigated the necrotic tissue. Finally, she was transferred to the burn center for advanced burn management. Treatment Progression in Trauma eISSN: 2508-8033 pISSN: 2508-5298
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