Journal of Trauma and Injury

Case Reports

Bleeding control of an injury to the infrarenal inferior vena cava and right external iliac vein by ipsilateral internal iliac artery and superficial femoral vein ligation after blunt abdominal trauma in Korea: a case report: Hoonsung Park, Maru Kim, Dae Sang Lee, Tae Hwa Hong, Doo-Hun Kim, Hang joo Cho; J Trauma Inj. 2023;36(4):441-446. Published online November 17, 2023; DOI: https://doi.org/10.20408/jti.2023.0019

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Abstract PDF: Inferior vena cava (IVC) injuries, while accounting for fewer than 0.5% of blunt abdominal trauma cases, are among the most difficult to manage. Despite advancements in prehospital care, transportation, operative techniques, and perioperative management, the mortality rate for IVC injuries has remained at 20% to 66% for several decades. Furthermore, 30% to 50% of patients with IVC injuries succumb during the prehospital phase. A 65-year-old male patient, who had been struck in the back by a 500-kg excavator shovel at a construction site, was transported to a regional trauma center. Injuries to the right side of the infrarenal IVC and the right external iliac vein (EIV) were suspected, along with fractures to the right iliac bone and sacrum. The injury to the right side of the infrarenal IVC wall was repaired, and the right internal iliac artery was ligated. However, persistent bleeding around the right EIV was observed, and we were unable to achieve proximal and distal control of the right EIV. Attempts at prolonged manual compression were unsuccessful. To decrease venous return, we ligated the right superficial femoral vein. This reduced the amount of bleeding, enabling us to secure the surgical field. We ultimately controlled the bleeding, and approximately 5 L of blood products were infused intraoperatively. A second-look operation was performed 2 days later, by which time most of the bleeding sites had ceased. Orthopedic surgeons then took over the operation, performing closed reduction and external fixation. Five days later, the patient underwent definitive fixation and was transferred for rehabilitation on postoperative day 22.; Summary

Delayed manifestation of Isolated Intramural Hematoma of the duodenum resulting from Blunt abdominal Trauma: Tae Sun Ha, Jun Chul Chung; J Trauma Inj. 2020;33(1):53-58. Published online March 30, 2020; DOI: https://doi.org/10.20408/jti.2019.042

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2 Citations

Duodenal injury following blunt abdominal trauma is a relatively unusual complication, and it may sometimes be difficult to distinguish a duodenal hematoma from duodenal perforation. According to recent reports, intramural hematomas typically resolve spontaneously with conservative treatment. Surgery, however, is occasionally necessary in some cases if the diagnosis is delayed, conservative therapy fails, or a high degree of suspicion of duodenal injury persists. We experienced a case of delayed manifestation of a duodenal intramural hematoma that was surgically treated.

Summary

Citations

Citations to this article as recorded by

Intramural duodenal hematoma: diagnosis and management of a rare entity
Álvaro Pérez-Rubio, Juan Carlos Sebastián-Tomás, Sergio Navarro-Martínez, Marta Córcoles Córcoles, Carlos Domingo del Pozo
Cirugía Española (English Edition).2023; 101(7): 515. CrossRef
Hematoma intramural duodenal: diagnóstico y manejo de una entidad infrecuente
Álvaro Pérez-Rubio, Juan Carlos Sebastián-Tomás, Sergio Navarro-Martínez, Marta Córcoles Córcoles, Carlos Domingo del Pozo
Cirugía Española.2023; 101(7): 515. CrossRef

Right Diaphragmatic Injury Accompanied by Herniation of the Liver: A Case Report: Min A Lee, Kang Kook Choi, Gil Jae Lee, Byung Chul Yu, Dae Sung Ma, Yang Bin Jeon, Jung Nam Lee, Min Chung; J Trauma Inj. 2016;29(2):43-46. Published online June 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.2.43

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Abstract PDF: Traumatic diaphragmatic injury (TDI) occurs in 1% of patients of blunt abdominal trauma. Most TDIs involve the left diaphragm, however the authors experienced TDI accompanied by a liver laceration of the right diaphragm. When detected early, TDI can be easily treated, however serious complications can occur if not. When diaphragmatic injury is suspected due to clinical manifestation, comprehensive analysis of the patient data including radiologic findings is important.; Summary

Isolated Duodenal Injury following Blunt Abdominal Trauma: Young Hoon Sul, Kwang Sik Cheon, Chang Eun Jang, Kyung Ha Lee, Sang Il Lee, In Sang Song; J Trauma Inj. 2015;28(1):47-50. Published online March 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.1.47

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Abstract PDF: The isolated duodenal injury following blunt abdominal trauma is extremely rare. Because, duodenal injury is usually presented with other intra-abdominal organs injuries such as hepatic injury, pancreatic injury due to the anatomical position. So, We report a case of isolated duodenal injury following blunt abdominal trauma, and the discuss about the related article.; Summary

Successful Angiographic Embolization of Superficial Circumflex Iliac Artery Rupture Caused by Blunt Abdominal Trauma: A Case Report: Sang Bong Lee, Sung Jin Park, Kwang Hee Yeo, Ho Hyun Kim, Chan Yong Park, Jae Hun Kim, Chang Wan Kim, Seon Uoo Choi, Seon Hee Kim, Jung Joo Hwang, Hyun Min Cho; J Trauma Inj. 2015;28(1):39-42. Published online March 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.1.39

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Abstract PDF: Lat. abdominal wall hematoma with active bleeding is very rare but need prompt bleeding control. We report successful treatment by angiographic embolization of superficial circumflex iliac artery rupture caused by blunt trauma. A 60-year-old woman presented painful, enlarging, lat. abdominal wall mass with ecchymosis caused by blunt abdominal trauma. Contrast leakage of superficial circumflex iliac a. within the lt. ext. oblique m. hematoma was confirmed by abdominal computed tomography. Angiographic embolization was performed successfully. Patient was discharged at 4th day after trauma without complication. Angiographic embolization is important treatment option of lat. abdominal wall hematoma with active bleeding replacing emergency surgery.; Summary

Original Articles

Impact of Initial Helical Abdominal Computed Tomography on the Diagnosis of Hollow Viscus Injury and Blunt Abdominal Traumare: Young Duck Cho, Yun Sik Hong, Sung Woo Lee, Sung Hyuk Choi, Young Hoon Yoon, Sung Ik Lim, Ik Jin Jang, Seung Won Baek; J Korean Soc Traumatol. 2008;21(1):28-35.

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Abstract PDF: PURPOSE
This study was conducted to examine the clinical significance IV-contrasted helical abdomen computed tomography (CT) as a diagnostic screening tool to evaluate hollow viscus injury in blunt abdominal trauma patients.
METHODS
This is a retrospective study encompassing 108 patients, presenting to Korea University Medical Center (KUMC) Emergency Department (ED) from January 2007 to December 2007, with an initial CT finding suggestive of intra-abdominal injury. An initial non-enhanced abdomen CT was taken, followed by an enhanced CT with intravenous contrast. Patients' demographic data, as well as the mechanisms of injury, were inquired upon and obtained, initial diagnosis, as dictated by specialized radiologists, were added to post-operational (post-OP) findings and to additional CT findings acquired during their hospital stays, and all were combined to arrive at final diagnosis. Initial CT findings were further compared with the final diagnosis, yielding values for sensitivity, specificity, and accuracy, as well as positive and negative predictive values. Patients were further divided into two groups, namely, those that underwent operational intervention and those that did not. The initial CT findings of each group were subsequently compared and analyzed.
RESULTS
Initial CT scans revealed abnormal findings in a total of 212 cases - solid organ injuries being the most common finding, as was observed in 97 cases. Free fluid accumulation was evident in another 69 cases. Based on the CT findings, 77 cases (71.3%) were initially diagnosed as having a solid organ injury, 20 cases (18.5%) as having a combined (solid organ + hollow viscus) injury, and 11 cases (10.2%), as having an isolated hollow viscus injury. The final diagnosis however, were somewhat different, with only 67 cases (62.0%) attributed to solid organ injury, 31 cases (28.7%) to combined injury (solid + hollow), and 10 cases (9.3%) to hollow viscus injury. The sensitivity (CI 95%) of the initial helical CT in diagnosing hollow viscus injury was 75.6%, and its specificity was 100%. The accuracy in diagnosing hollow viscus injury was also meaningfully lower compared to that in diagnosis of solid organ injury. Among patients initially diagnosed with solid organ injuries, 10 patients (2 from follow-up CT and 8 from post-OP finding) turned out to have combined injuries. A total of 38 patients underwent an operation, and the proportion of initial CT findings suggesting free air, mesenteric hematoma or bowel wall thickening turned out to be significantly higher in the operation group.
CONCLUSION
Abdominal CT was a meaningful screening test for hollow viscus injury, but the sensitivity of abdominal CT was significantly lower in detecting hollow viscus injury as compared to solid organ injury. This calls for special consideration and careful observation by the ED physicians when dealing with cases of blunt abdominal trauma.; Summary

Usefulness of FAST for Evaluation of Blunt Abdominal Trauma Patients: Yong Sik Chu, Ok Jun Kim, Sung Uk Choi, Jung Han Lee; J Korean Soc Traumatol. 2006;19(2):135-142.

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Abstract PDF: PURPOSE
We planned to determine the diagnostic capability of focused assessment with sonography for trauma (FAST) in cases of blunt abdominal injury (BAI).
METHODS
A retrospective analysis of FAST sheets was performed from April 2002 to December 2004. During the study period, 135 BAI patients were evaluated with FAST at the Emergency Department of Bundang CHA Hospital. Of this group, twenty-eight patients were excluded, leaving 107 patients for analysis. Abdomen CT (computerized tomography) or exploratory laparotomy confirmed the presence of hemoperitoneum. At the secondary survey, patients underwent a three-view FAST examination (LogicQ; General Electric, Waukesha, USA) by an emergency physician, followed within 2 hours by an abdomen CT or exploratory laparotomy. The FAST examination was considered positive if it demonstrated evidence of free intra-abdominal fluid.
RESULTS
There were 45 true-positive FAST examination, 57 true-negatives, 1 false-positive, and 4 false negatives (sensitivity 91.8%, specificity 98.3%, positive predictive value 97.8%, negative predictive value 93.4%). The area under the ROC curve was 0.951 for the FAST examination.
CONCLUSION
FAST is a highly reliable method for screening patients suspected of having BAI for the presence or absence of hemoperitoneum.; Summary

Original article

Clinical Characteristics of Small Bowel Perforation due to Blunt Abdominal Trauma: Jung Min Bae; J Korean Soc Traumatol. 2011;24(2):125-128.

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Abstract PDF: PURPOSE
Blunt small bowel injury (SBI) is frequently combined other organ injury. So, clinical outcome and characteristics of SBI are influenced by other combined injuries. Thus, we analyzed isolated SBI patients and studied clinical outcome and characteristics.
METHODS
Between 2005 and 2010, 36 consecutive patients undergoing laparotomy due to isolated SBI were identified in a retrospectively collected. Database. Clinical outcome and characteristics were analyzed.
RESULTS
Laparotomy was performed in 36 patients. Primary repair was performed 17 patients. Segmental resection of small bowel was performed 19 patients. Median time gap from trauma to operation was 9 hours. In 24 hours from trauma, operation was performed 31 patients. Post operative death was 5 patients. Mean hospital stay was 18 days and median hospital stay was 12 days. There were significant differences between operation type and minor complication and hospital stay. And there were significant differences between time gap in 24 hours and minor complication. But, there were no significant between time gap and mortality.
CONCLUSION
Although this study had many limitations, some valuable information was produced. When operation above 24 hours was delayed in SBI, minor complications were significantly increased. Segmental resection of small bowel in SBI were significantly increased minor complications and hospital stay. So, preventive measures for surgical site infection was important to reduce wound complication and hospital stay. Further continuous study and multi-center study were should be performed to improve clinical outcome in SBI.; Summary

Original Articles

Clinical Aspects and Prognostic Factors Of Small Bowel Perforation After Blunt Abdominal Trauma: Ji Won Kim, Seung Su Kwak, Mun Ki Park, Yong Pyeong Koo; J Korean Soc Traumatol. 2011;24(2):82-88.

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Abstract PDF: PURPOSE
The incidence of abdominal trauma with intra-abdominal organ injury or bowel rupture is increasing. Articles on the diagnosis, symptoms and treatment of small bowel perforation due to blunt trauma have been reported, but reports on the relationship of mortality and morbidity to clinical factors for prognosis are minimal. The purposes of this study are to evaluate the morbidity and mortality of patients with small bowel perforation after blunt abdominal trauma on the basis of clinical examinationand to analyze factors associated with the prognosisfor blunt abdominal trauma with small bowel perforation.
METHODS
The clinical data on patients with small bowel perforation due to blunt trauma who underwent emergency surgery from January 1994 to December 2009 were retrospectively analyzed. The correlation of each prognostic factor to morbidity and mortality, and the relationship among prognostic factors were analyzed.
RESULTS
A total of 83 patients met the inclusion criteria: The malewas 81.9% .The mean age was 45.6 years.The mean APACHE II score was 5.75.The mean time interval between injury and surgery was 395.9 minutes.The mean surgery time was 111.1 minutes. Forty seven patients had surgery for ileal perforations, and primary closure was done for 51patients. The mean admission period was 15.3 days, and the mean fasting time was 4.5 days. There were 6 deaths (7.2%), and 25 patientssuffered from complications.
CONCLUSION
The patient's age and the APACHE II score on admission were important prognostic factors that effecteda patient's progress. Especially, this study shows that the APACHE II score had effect on the operation time, admission period, the treatment period, the fasting time, the mortality rate, and the complication rate.; Summary

Prognosis for Blunt Abdominal Trauma Patients with Contrast Extravasation on the Abdominopelvic CT Scan: Hyung Jin Shin, Kang Hyun Lee, Young Soo Kwak, Sun Hyu Kim, Hyun Kim, Sung Oh Hwang; J Korean Soc Traumatol. 2009;22(1):57-64.

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Abstract PDF: PURPOSE
Computed tomography (CT) is an accurate test for evaluating hemodynamically stable patients with blunt abdominal trauma. Until now, there have been few studies concentrating on the diagnostic and prognostic significance of the intravenous contrast extravasation (CE) site. We investigated the site of CE on abdominopelvic CT (APCT) and its effect on treating trauma patients and predicting the clinical outcome.
METHODS
The 50 patients admitted to our emergency department with blunt abdominal trauma showing CE on APCT from January 2004 to September 2006 were included in this study. Patients were prospectively collected, and medical records were reviewed and analyzed. The patients'clinical and lab findings, Focused Assessment with Sonography for Trauma (FAST) findings, CT findings were analyzed. CE sites were classified as intraperitoneal, retroperitoneal, and pelvic cavity and were correlated with post-treatment complications, mortality, and morbidity.
RESULTS
Of the 50 patients (mean age : 45+/-18years, 29 males, 21 females) included in our study, 33 patients died (66%). There was no correlation between CE site and ICU or total hospitalization duration (p=0.553, p=0.523). During the first 24 hours of resuscitation, the pelvic cavity group required a mean of 20 units more of packed red blood cell (pRBC) transfusion compared to other groups (p=0.003). In the intraperitoneal group, more patients received operative invasive intervention - either laparotomy or embolization (p=0.025). The intraperitoneal group had the highest mortality, with 13 deaths (11/33, 39%), and the highest early mortality rate (10/13, 76%) in the first 24 hours (p=0.001).
CONCLUSION
Intraperitoneal CE on the CT scan in cases of blunt abdominal trauma is regarded as an indication of a need for invasive intervention (either angiography or laparotomy) and of a higher mortality rate in the first 24 hours. A pelvic cavity CE rquires more aggressive transfusion with pRBC. However, the CT findings themselves showed no significant correlation with overall mortality, morbidity, or hospitalization.; Summary

Case Reports

Common Iliac Artery Injury due to Blunt Abdominal Trauma without a Pelvic Bone Fracture: Pil Young Jung, Chun Sung Byun, Joong Hwan Oh, Keum Seok Bae; J Trauma Inj. 2014;27(4):215-218.

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Abstract PDF: Blunt abdominal trauma may often cause multiple vascular injuries. However, common iliac artery injuries without associated bony injury are very rarely seen in trauma patients. In the present case, a 77-year-old male patient who had no medical history was admitted via the emergency room with blunt abdominal trauma caused by a forklift. At admission, the patient was in shock and had abdominal distension. On abdomino-pelvic computed tomography (CT), the patient was seen to have hemoperitoneum, right common iliac artery thrombosis and left common iliac artery rupture. During surgery, an additional injury to inferior vena cava was confirmed, and a primary repair of the inferior vena cava was successfully performed. However, the bleeding from the left common iliac artery could not be controlled, even with multiple sutures, so the left common iliac artery was ligated. Through an inguinal skin incision, the right common iliac artery thrombosis was removed with a Forgaty catheter and a femoral-to-femoral bypass graft was successfully performed. After the post-operative 13th day, on a follow-up CT angiography, the femoral-to-femoral bypass graft was seen to have good patency, but a right common iliac artery dissection was diagnosed. Thus, a right common iliac artery stent was inserted. Finally, the patient was discharged without complications.; Summary

Traumatic Lumbar Hernia: Report of a Case: Gil Jae Lee, Min Chung, Byung Chul Yu; J Trauma Inj. 2013;26(3):222-225.

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Abstract PDF: The occurrence of traumatic hernia is rare. However, traumatic lumbar hernias are the most frequently occurring traumatic hernias. Superior lumbar hernias occur more frequently than inferior lumbar hernias, but for anatomical reasons, among traumatic lumbar hernias, inferior lumbar hernias occur more frequently than superior lumbar hernias. Repair of a lumbar hernia is very difficult. Mesh fixation to the bony part and general weakness of surrounding tissue make repair of a lumbar hernia tricky. A traumatic lumbar hernia was repaired using transfascial fixation around the defect to secure the mesh. This technique is another choice for a lumbar hernia technique.; Summary

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