- Hydronephrosis during Conservative Treatment for a Renal Injury Patient
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Maru Kim, Joongsuck Kim, Sung Jeep Kim, Hang Joo Cho
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J Trauma Inj. 2017;30(2):47-50. Published online June 30, 2017
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DOI: https://doi.org/10.20408/jti.2017.30.2.47
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 Abstract
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- A 21-year-old male visited our emergency room. He could not remember the mechanism of injury. He was found beside a motorcycle. Initial vital sign was stable. Observation and conservative treatment were planned at the intensive care unit (ICU). On the third day at ICU, he complained sudden flank pain. It was colicky and hard to control. Without the pain, he had no specific symptom, sign, or laboratory findings. On computed tomography, renal pelvis was filled with hematoma which induced hydronephrosis. Double-J catheter and percutaneous nephrostomy was implemented by an intervention radiologist. Hematome in the renal pelvis was aspirated during the procedure. Symptom of the patient was subsided after the procedure. He was discharged without specific complications.
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Summary
- Temporary Closure for Sternotomy in Patient with Massive Transfusion Might Be Lethal
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Maru Kim, Joongsuck Kim, Sung Jeep Kim, Hang Joo Cho
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J Trauma Inj. 2017;30(1):12-15. Published online March 31, 2017
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DOI: https://doi.org/10.20408/jti.2017.30.1.12
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- A 58-year-old male visited our emergency room for multiple traumas from explosion. On initial evaluation, hemopneumoperitoneum with liver laceration (grade 4) and colon perforation was identified. Hemopericardium with cardiac tamponade was also identified. Shrapnel was detected in the right ventricle. Damage control surgery was planned due to condition of hypotension. In operation room, control over bleeding was achieved after sternotomy, pericardiotomy, and laparotomy. Massive transfusion was done during operation. After gauze packing, operation was terminated with temporary closure (TC). Sanguineous fluid was drained profusely. Disseminated intravascular coagulopathy was confirmed through laboratory findings. No extravasation was discovered at hepatic angiogram. On re-operation, there was no active bleeding but oozing from sternotomy site was identified. Bone bleeding was impossible to control. Finally, reoperation was ended after gauze packing and TC all over again. The patient could survive for only a day after re-operation.
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Summary
- Retroperitoneal Gauze Packing with Vacuum-Associated Closure for Pelvic Fracture with Hemodynamic Instability
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Sung Jeep Kim, Ji Hoon T Kim
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J Trauma Inj. 2014;27(2):29-32.
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- Pelvic bone fracture with hemodynamic instability is fatal and the mortality rate can range up to 40%. Despite the big advances in the treatment of massive bleeding and hemorrhagic shock, the mortality associated with hemodynamically unstable pelvic bone fractures remains high. The gold standard of treatment for pelvic bone fracture with hemodynamic instability has not yet been determined and is an issue of main discussion among many doctors. Retroperitoneal packing is not yet wide spread in Korea, but is a good modality for managing of massive bleeding from pelvic bone fractures when an angiography suite or an expert surgeon is not available. A vacuum-assisted closure (VAC) system can also be applied with retroperitoneal packing in the manner of damage control surgery and open abdomen surgery. We present the case of a 51-year-old male who had a pelvic bone fracture with massive bleeding. We performed retroperitoneal gauze packing with a VAC system for the first time. The postoperative vital signs of patient were immediately stable, the massive bleeding was easily and quickly controlled, and the amount of transfusion of blood components was reduced.
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