Journal of Trauma and Injury

Original Articles

Initial assessment of hemorrhagic shock by trauma computed tomography measurement of the inferior vena cava in blunt trauma patients: Gun Ho Lee, Jeong Woo Choi; J Trauma Inj. 2022;35(3):181-188. Published online June 10, 2022; DOI: https://doi.org/10.20408/jti.2021.0066

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Abstract PDF: Purpose
Inferior vena cava (IVC) collapse is related to hypovolemia. Sonography has been used to measure the IVC diameter, but there is variation depending on the skill of the operator and it is difficult to obtain accurate measurements in patients who have a large amount of intestinal gas or are obese. As a modality to obtain accurate measurements, we measured the diameters of the IVC and aorta on trauma computed tomography scans and investigated the correlation between the IVC to aorta ratio and the shock index in blunt trauma patients.
Methods
We retrospectively analyzed the medical records of 588 trauma patients who were transferred to the regional trauma center (level 1) of Wonkang University hospital from March 2020 to February 2021. We included trauma patients 18 years or older who met the trauma activation criteria and underwent trauma computed tomography scans with intravenous contrast within 40 minutes of admission. The shock index was calculated from vital signs before trauma computed tomography scan, and measurements of the anteroposterior diameter of the IVC (AP), the transverse diameter of the IVC (T), and aorta were made 10 mm above the right renal vein in the venous phase.
Results
Overall, 271 patients were included in this study, of whom 150 had a shock index ≤0.7 and 121 had a shock index >0.7. The T to AP ratio and AP to aorta ratio were significantly different between groups. Cutoffs were identified for the T to AP ratio and AP to aorta ratio (2.37 and 0.62, respectively) that produced clinically useful sensitivity and specificity for predicting a shock index >0.7, demonstrating moderate accuracy (T to AP ratio: area under the curve, 0.71; sensitivity, 59%; specificity, 87% and AP to aorta ratio: area under the curve, 0.70; sensitivity, 55%; specificity, 91%).
Conclusions
The T to AP ratio and AP to aorta ratio are useful for predicting hemorrhagic shock in trauma patients.; Summary

Could the Injury Severity Score be a new indicator for surgical treatment in patients with traumatic splenic injury?: HyeJeong Jeong, SungWon Jung, Tae Gil Heo, Pyong Wha Choi, Jae Il Kim, Sung Min Jung, Heungman Jun, Yong Chan Shin, Eunhae Um; J Trauma Inj. 2022;35(3):189-194. Published online May 30, 2022; DOI: https://doi.org/10.20408/jti.2021.0065

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Abstract PDF Supplementary Material: Purpose
The purpose of this study was to determine whether a higher Injury Severity Score (ISS) could serve as an indicator of splenectomy in patients with traumatic splenic lacerations.
Methods
A total of 256 cases of splenic laceration were collected from January 1, 2005 to December 31, 2018. After the application of exclusion criteria, 105 were eligible for this study. Charts were reviewed for demographic characteristics, initial vital signs upon presentation to the emergency room, Glasgow Coma Scale, computed tomography findings, ISS, and treatment strategies. The cases were then divided into nonsplenectomy and splenectomy groups for analysis.
Results
When analyzed with the chi-square test and t-test, splenectomy was associated with a systolic blood pressure lower than 90 mmHg, a Glasgow Coma Scale score lower than 13, active bleeding found on computed tomography, a splenic laceration grade greater than or equal to 4, and an ISS greater than 15 at presentation. However, in multivariate logistic regression analysis, only active bleeding on computed tomography showed a statistically significant relationship (P=0.014).
Conclusions
Although ISS failed to show a statistically significant independent relationship with splenectomy, it may still play a supplementary role in traumatic splenic injury management.; Summary

Case Reports

The management of Pancreatic fistula Complicated by Gastric fistulation following Emergency Splenectomy: Tan Jih Huei, Henry Tan Chor Lip, Chow Sing Thou, Yuzaidi Mohamad, Rizal Imran Alwi; J Trauma Inj. 2020;33(1):43-47. Published online March 30, 2020; DOI: https://doi.org/10.20408/jti.2019.036

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Abstract PDF

Pancreatic and gastric fistulas are rare complications of emergency splenectomy, and it is extremely rare for a pancreatic fistula to be further complicated by a fistulation into the stomach. Here, we present a case of pancreatogastric fistula in a 60-year-old man who experienced polytrauma due to a blunt mechanism. He underwent emergency splenectomy for splenic injury and developed a pancreatic fistula as a complication. A percutaneous endoscopic procedure was performed to drain the fistula, after which he developed a pancreatogastric fistula as a further complication. A double-pigtail stent was inserted via gastroscopy into the fistula tract to allow internal drainage of the pancreatic collection into the stomach cavity. When a pancreatic fistula is complicated by gastric fistulation, endoscopic stenting of the pancreatogastric fistula tract for internal drainage is an effective treatment option.

Summary

Citations

Citations to this article as recorded by

Successful percutaneous transgastric diversion of a chronic post-operative combined pancreaticocutaneous and gastrocutaneous fistula using a snare-target technique: A case report
Katherine J. Li, Ken Leslie, Derek W. Cool
International Journal of Surgery Case Reports.2021; 80: 105685. CrossRef

Splenic Autotransplantation after Blunt Spleen Injury in Children: Hojun Lee, Byung Hee Kang, Junsik Kwon, John Cook-Jong Lee; J Trauma Inj. 2018;31(2):87-90. Published online August 31, 2018; DOI: https://doi.org/10.20408/jti.2018.31.2.87

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1 Citations

Abstract PDF

Non-operative management has been preferred in blunt spleen injury. Moreover children are more susceptible to post-splenectomy infection, spleen should be preserved if possible. However, splenectomy is inevitable to patients with severe splenic injury. Therefore splenic autotransplantation could be the last chance for preserving splenic function in these patients although efficacy has not proven. Here we reported four cases of children who were underwent splenic autotransplantation successfully after blunt trauma.

Summary

Citations

Citations to this article as recorded by

Stumpfes Bauchtrauma bei Kindern und Jugendlichen: Behandlungskonzepte in der Akutphase
M. C. Schunn, J. Schäfer, F. Neunhoeffer, J. Lieber, J. Fuchs
Die Chirurgie.2023; 94(7): 651. CrossRef

Original Article

Clinical Outcomes of Splenic Injury: Seung Hyun Baek, Sung Jin Park, Jae Hoon Kim, Hyun Seong Kim, Dae Hwan Kim, Hong Jae Jo, Hyung Il Seo; J Korean Soc Traumatol. 2012;25(2):44-48.

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Abstract PDF: PURPOSE
The management of splenic injuries has shifted from a splenectomy to splenic preservation owing to immunity. The purpose of this study was to assess the kinds of management and outcomes through a review of our experience with splenic injuries.
METHODS
We retrospectively reviewed 47 patients with traumatic splenic injuries using by electronic medical records from Jan. 2007 and Dec. 2011. Splenic injuries were classified according to the American Association for the Surgery of Trauma (AAST) grading system.
RESULTS
There were 11 falls, 11 traffic accidents, 10 motorcylcle accidents, 10 pedestrian accidents and 5 abdominal blunt traumas. Low-grade injured patients (< or =Grade III) were 29 of 43(61.7%), and High-grade injured patients (> or =Grade IV) were 18 of 43(38.3%). In 34 patients, non-surgical treatment was performed, and 14 patients underwent a splenectomy. There were relatively more high-grade in older patients, and the highgrade-injury group showed need for a transfusion (p=0.002), more need for a splenectomy (p<0.001), a longer mean hospital stay (p=0.036), a longer ICU stay (p=0.045) and more combined organ injury (p=0.036).
CONCLUSION
Conservative treatment should be considered in low-grade-injury patients (< or =Grade III). A Splenectomy was performed on 56% of the patients with Grade IV injuries, so a splenectomy should be considered carefully in such patients. In patients with a grade V injury, we think surgical treatment may be needed.; Summary

Case Report

Laparoscopic Splenectomy in a Case of Stable Blunt Abdominal Trauma: Hang Joo Cho, Yeon Young Kyoung, Ju Suk Oh, Young Min Oh, Se Min Choe, Kyoung Ho Choi; J Korean Soc Traumatol. 2010;23(2):192-195.

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Abstract PDF: Splenic rupture is a frequent surgical emergency in blunt abdominal trauma patients. There are several treatment options, including conservative treatment, a partial splenectomy, splenorrhaphy, and a splenectomy for splenic injury. Although reports on the safety and the efficacy of an elective laparoscopic splenectomy are abundant in the literature, a laparoscopic splenectomy for a ruptured spleen has only been reported in a few cases. We report a case of a laparoscopic splenectomy in the patient with Grade III traumatic splenic injury. To our knowledge, this is the first report in which a laparoscopic splenectomy was performed in Korea for the treatment of a traumatic splenic injury.; Summary

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