A 52-year-old man experienced blunt trauma upon falling from a height of 40 m while trying to repair the elevator. The patient’s systolic blood pressure and hemoglobin levels were 60 mmHg and 7.0 g/dL, respectively, upon admission. A large volume of bloody discharge was observed in the open wound of the perianal area and sacrum. A computed tomography scan revealed an open comminuted sacral fracture with multiple contrast blushes. He underwent emergency laparotomy. Both internal iliac artery ligations were performed to control bleeding from the pelvis. Protective sigmoid loop colostomy was performed because of massive injury to the anal sphincters and pelvis. Pad packing was performed for a sacral open wound and perineal wound at the prone position. After resuscitation of massive transfusion, he underwent the second operation 2 days after the first operation. The pad was removed and the perineal and sacral open wounds were closed. After the damage-control surgery, he recovered safely. In this case, the hemodynamically unstable, open comminuted sacral fracture was treated safely by internal iliac artery ligation with pad packing.

Citations

Citations to this article as recorded by  

• Penetrating sacral injury with a metallic pipe: a case report and literature review
  Mahnjeong Ha, Kyoung Hyup Nam, Jae Hun Kim, In Ho Han
  Journal of Trauma and Injury.2022; 35(2): 131.     CrossRef

Extrahepatic bile duct injury is commonly associated with hepatic, duodenal, or pancreatic injuries, and isolated extrahepatic bile duct injury is rare. We report a patient who presented with an isolated extrahepatic bile duct injury after blunt trauma. A 50-year-old man was referred to our hospital after having suffered a fall down injury. His laboratory findings showed hyperbiliribinemia with elevated aspartate aminotransferase and alanine aminotransferase level. Initial abdominal computed tomography (CT) showed a mild degree of hemoperitoneum without evidence of abdominal solid organ injury. On the 3rd day of hospitalization, the patient complained of dyspnea and severe abdominal discomfort. Follow-up abdominal CT showed no significant interval change. Owing to the patient’s condition, Emergency laparotomy revealed a large amount of bile-containing fluid collection and about 1 cm in size laceration on the left lateral side of the common hepatic duct. Primary repair of the injured bile duct with T-tube insertion was performed On postoperative day (POD) 30, endoscopic retrograde cholangiopancreatography showed minimal bile leakage and endoscopic sphincteroplasty and endoscopic retrograde biliary drainage were performed. On POD 61, the T-tube was removed and the patient was discharged.

Laparoscopy has been one of the most effective modalities in various surgical situations, although its use in trauma patients has some limitations. The benefits of laparoscopy include cost-effectiveness, shorter length of hospital stay, and less postoperative pain. This report describes diagnostic laparoscopy and laparoscopic diverting sigmoid loop colostomy in penetrating extraperitoneal rectal injury. A 41-year-old male presented with perineal pain following penetrating trauma caused by a tree limb. Computed tomography showed air density in the perirectal space and retroperitoneum. As his vital signs were stable, we performed diagnostic laparoscopy and confirmed no intraperitoneal perforation. Therefore, laparoscopic diverting sigmoid loop colostomy was performed. He was discharged without any complications despite underlying hepatitis C-related cirrhosis. Colostomy closure was performed 3 months later.

Citations

Citations to this article as recorded by  

• The floating rectum
  Sean Ng Kwet Chi Ng Ying Kin, William Jiang, Asiri Arachchi, Hanumant Chouhan
  ANZ Journal of Surgery.2022; 92(1-2): 264.     CrossRef