- Pseudo-renal Failure Caused by Urinary Bladder Rupture in Multiple Trauma Patient
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Jihoon Jang, Kyoung Hoon Lim
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J Trauma Inj. 2016;29(4):191-194. Published online December 31, 2016
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DOI: https://doi.org/10.20408/jti.2016.29.4.191
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- Pseudo-renal failure presents with renal failure characteristics, such as hypercreatininemia and hyperkalemia without a change in glomerular filtration rate or structure of the kidney. Pseudo-renal failure due to trauma is difficult to diagnose, because symptoms are non-specific and other factors may cause hypercreatininemia and hyperkalemia. In a trauma patient, especially one with pelvic injury, the abrupt elevation of potassium, blood urea nitrogen, and creatinine levels without previous medical history is a key feature in the diagnosis of urinary ascites. We report a case of pseudo-renal failure caused by intraperitoneal bladder rupture in a multiple trauma patient.
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- Forearm Replantation for a Patient Presented with Major Amputation Injury: A Case Report
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Jihoon Jang, Kyoung Hoon Lim, Joon Woo Kim, Hyung Kee Kim
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J Trauma Inj. 2016;29(4):187-190. Published online December 31, 2016
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DOI: https://doi.org/10.20408/jti.2016.29.4.187
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- With the development of safety measures for employees who work with dangerous machinery, the frequency of amputation injuries has been decreasing with resultant decrease in replantation procedures. However, in some patients with major amputation injury, replantation is still necessary for the preservation of limb and it's function. The replantation of the upper extremity (UE) is a complex and technically demanding surgical procedure. For the successful replantation of UE, the type of injury, reconstruction sequence, ischemic time, and other combined injury of patient should be considered. We report a case of major amputation of UE by guillotine-type injury and discuss the treatment process of this patient.
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- Delayed Posttraumatic Spinal Epidural Hematoma: Importance of Early Surgical Treatment for Neurologic Deficits
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Deok Heon Lee, Tak Hyuk Oh, Jong Chul Lee, Kyoung Hoon Lim
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J Trauma Inj. 2016;29(4):176-179. Published online December 31, 2016
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DOI: https://doi.org/10.20408/jti.2016.29.4.176
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- Delayed posttraumatic spinal epidural hematoma is an extremely rare disease, and it remains a challenge for surgical teams of trauma centers. Magnetic resonance imaging is an essential tool for early diagnosis, and emergent evacuation of the hematoma is the best choice of treatment. We report the case of a 33-year old man with posttraumatic epidural hematoma in the thoracic spine (T10 and T11 levels), who developed an abrupt-onset paraplegia 5 days after the trauma.
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- Treatment Outcomes of Traumatic Duodenal Injury
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Byunghyuk Yu, Jayun Cho, Kyoung Hoon Lim, Jinyoung Park
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J Trauma Inj. 2015;28(3):129-133. Published online September 30, 2015
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DOI: https://doi.org/10.20408/jti.2015.28.3.129
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- PURPOSE
The purpose of this study is to evaluate the surgical outcome of duodenal injuries and to analyze the risk factors related to the leakage after surgical treatment.
METHODS
A retrospective review of 31 patients with duodenal injuries who managed by surgical treatment was conducted from December 2000 to May 2014. The demographic characteristics, injury mechanism, site of duodenal injury, association of intraabdominal organ injuries, injury severity score (ISS), abdominal abbreviated injury scale (AIS), injury-operation time lag, surgical treatment methods, complications, and mortality were reviewed.
RESULTS
Duodenal injury was more common in male. Twenty four (77.4%) patients were injured by blunt trauma. The most common injury site was in the second portion of the duodenum (n=19, 58.6%). Fourteen patients (45.2%) had other associated intraabdominal organ injuries. The mean ISS is 13.6+/-9.6. The mean AIS is 8.9+/-6.5. Eighteen patients (58.1%) were treated by primary closure. The remaining 13 patients underwent various operations, including exploratory laparotomy (n=4), pancreaticoduodenectomy (n=3), pyloric exclusion (n=3), Resection with end-to-end anastomosis (n=2), and duodenojejunostomy (n=1). Most common postoperative complications were intraabdominal abscess (n=9) and renal failure (n=9). Mortality rate was 9.7%.
CONCLUSION
ISS, AIS>10, operative time, pancreaticoduodenectomy, sepsis, and renal failure are significant predictors of a postoperative leak after duodenal injury. Careful management is needed to prevent a potential leak in patient with these findings.
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Summary
- Non-occlusive Mesenteric Ischemia (NOMI) Secondary to Traumatic Hemorrhagic Shock: Case Report
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Kyoung Hoon Lim, Hee Kyung Jung, Jayun Cho, Sang Cjeol Lee, Jinyoung Park
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J Trauma Inj. 2014;27(4):204-207.
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- Non-occlusive mesenteric ischemia (NOMI) encompasses all forms of mesenteric ischemia with patent mesenteric arteries. NOMI is commonly caused by decreased cardiac output resulting in hypoperfusion of peripheral mesenteric arteries. We report a case of NOMI secondary to hemorrhagic shock and rhabdomyolysis due to trauma. A 42-year-old man presented to our trauma center following a pedestrian trauma. On arrival, he was drowsy and in a state of hemorrhagic shock. He was found to have multiple fractures, both lung contusion and urethral rupture. An initial physical examination and abdominal computed tomography (CT) scan revealed no evidence of intra-abdominal injury. High doses of catecholamine were administered for initial 3 days due to unstable vital sign. On day 25 of hospitalization, follow-up abdominal CT scan demonstrated that short segment of small bowel loop was dilated and bowel wall was not enhanced. During exploratory laparotomy, necrosis of the terminal ileum with intact mesentery was detected and ileocecectomy was performed. His postoperative course was uneventful and is under rehabilitation.
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- Delayed Presentation of a Post-traumatic Mesenteric Arteriovenous Fistula: A Case Report
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Jayun Cho, Heekyung Jung, Hyung Kee Kim, Kyoung Hoon Lim, Jae Min Chun, Seung Huh, Jinyoung Park
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J Trauma Inj. 2013;26(3):248-251.
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- INTRODUCTION: A post-traumatic mesenteric arteriovenous fistula (AVF) is extremely rare.
CASE
REPORT: A previously healthy 26-year-old male was injured with an abdominal stab wound. Computed tomography (CT) showed liver injury, pancreas injury and a retropancreatic hematoma. We performed the hemostasis of the bleeding due to the liver injury, a distal pancreatectomy with splenectomy and evacuation of the retropancreatic hematoma. On the 5th postoperative day, an abdominal bruit and thrill was detected. CT and angiography showed an AVF between the superior mesenteric artery (SMA) and the inferior mesenteric vein with early enhancement of the portal vein (PV). The point of the AVF was about 4 cm from the SMA's orifice. After an emergent laparotomy and inframesocolic approach, the isolation of the SMA was performed by dissection and ligation of adjacent mesenteric tissues which was about 6 cm length from the nearby SMA orifice, preserving the major side branches of the SMA, because the exact point of the AVF could not be identified despite the shunt flow in the PV being audible during an intraoperative hand-held Doppler-shift measurement. After that, the shunt flow could not be detected by using an intraoperative hand-held Doppler-shift measuring device. CT two and a half months later showed no AVF. There were no major complications during a 19-month follow-up period.
CONCLUSION
Early management of a post-traumatic mesenteric AVF is essential to avoid complications such as hemorrhage, congestive heart failure and portal hypertension.
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Summary
- Treatment of Subclavian Artery Injury in Multiple Trauma Patients by Using an Endovascular Approach: Two Cases
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Jayun Cho, Heekyung Jung, Hyung Kee Kim, Kyoung Hoon Lim, Jinyoung Park, Seung Huh
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J Trauma Inj. 2013;26(3):243-247.
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- INTRODUCTION: Surgical treatment of subclavian artery (SA) injury is challenging because approaching the lesion directly and clamping the proximal artery is difficult. This can be overcome by using an endovascular technique.
CASE
1: A 37-year-old male was drawn into the concrete mixer truck. He had a right SA injury with multiple traumatic injuries: an open fracture of the right leg with posterior tibial artery (PTA) injury, a right hemothorax, and fractures of the clavicle, scapula, ribs, cervical spine and nasal bone. The injury severity score (ISS) was 27. Computed tomography (CT) showed a 30-mm-length thrombotic occlusion in the right SA, which was 15 mm distal to the vertebral artery (VA). A self-expandable stent(8 mmx40 mm in size) was deployed through the right femoral artery while preserving VA flow, and the radial pulse was palpable after deployment. Other operations were performed sequentially. He had a viable right arm during a 13-month follow-up period.
CASE
2: A 25-year-old male was admitted to our hospital due to a motorcycle accident. The ISS was 34 because of a hemothorax and open fractures of the mandible and the left hand. Intraoperative angiography was done through a right femoral artery puncture. Contrast extravasation of the SA was detected just outside the left rib cage. After balloon catheter had been inflated just proximal to the bleeding site, direct surgical exploration was performed through infraclavicular skin incision. The transected SA was identified, and an interposition graft was performed using a saphenous vein graft. Other operations were performed sequentially. He had a viable left arm during a 15-month follow-up period.
CONCLUSION
The challenge of repairing an SA injury can be overcome by using an endovascular approach.
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