- Emergency department laparotomy for patients with severe abdominal trauma: a retrospective study at a single regional trauma center in Korea
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Yu Jin Lee, Soon Tak Jeong, Joongsuck Kim, Kwanghee Yeo, Ohsang Kwon, Kyounghwan Kim, Sung Jin Park, Jihun Gwak, Wu Seong Kang
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J Trauma Inj. 2024;37(1):20-27. Published online January 12, 2024
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DOI: https://doi.org/10.20408/jti.2023.0072
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- Purpose
Severe abdominal injuries often require immediate clinical assessment and surgical intervention to prevent life-threatening complications. In Jeju Regional Trauma Center, we have instituted a protocol for emergency department (ED) laparotomy at the trauma bay. We investigated the mortality and time taken from admission to ED laparotomy.
Methods We reviewed the data recorded in our center’s trauma database between January 2020 and December 2022 and identified patients who underwent laparotomy because of abdominal trauma. Laparotomies that were performed at the trauma bay or the ED were classified as ED laparotomy, whereas those performed in the operating room (OR) were referred to as OR laparotomy. In cases that required expeditious hemostasis, ED laparotomy was performed appropriately.
Results From January 2020 to December 2022, 105 trauma patients admitted to our hospital underwent emergency laparotomy. Of these patients, six (5.7%) underwent ED laparotomy. ED laparotomy was associated with a mortality rate of 66.7% (four of six patients), which was significantly higher than that of OR laparotomy (17.1%, 18 of 99 patients, P=0.006). All the patients who received ED laparotomy also underwent damage control laparotomy. The time between admission to the first laparotomy was significantly shorter in the ED laparotomy group (28.5 minutes; interquartile range [IQR], 14–59 minutes) when compared with the OR laparotomy group (104 minutes; IQR, 88–151 minutes; P <0.001). The two patients who survived after ED laparotomy had massive mesenteric bleeding, which was successfully ligated. The other four patients, who had liver laceration, kidney rupture, spleen injury, and pancreas avulsion, succumbed to the injuries.
Conclusions Although ED laparotomy was associated with a higher mortality rate, the time between admission and ED laparotomy was markedly shorter than for OR laparotomy. Notably, major mesenteric hemorrhages were effectively controlled through ED laparotomy.
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Summary
- Angioembolization performed by trauma surgeons for trauma patients: is it feasible in Korea? A retrospective study
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Soonseong Kwon, Kyounghwan Kim, Soon Tak Jeong, Joongsuck Kim, Kwanghee Yeo, Ohsang Kwon, Sung Jin Park, Jihun Gwak, Wu Seong Kang
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J Trauma Inj. 2024;37(1):28-36. Published online January 12, 2024
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DOI: https://doi.org/10.20408/jti.2023.0076
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- Purpose
Recent advancements in interventional radiology have made angioembolization an invaluable modality in trauma care. Angioembolization is typically performed by interventional radiologists. In this study, we aimed to investigate the safety and efficacy of emergency angioembolization performed by trauma surgeons.
Methods We identified trauma patients who underwent emergency angiography due to significant trauma-related hemorrhage between January 2020 and June 2023 at our trauma center. Until May 2022, two dedicated interventional radiologists performed emergency angiography at our center. However, since June 2022, a trauma surgeon with a background and experience in vascular surgery has performed emergency angiography for trauma-related bleeding. The indications for trauma surgeon–performed angiography included significant hemorrhage from liver injury, pelvic injury, splenic injury, or kidney injury. We assessed the angiography results according to the operator of the initial angiographic procedure. The term “failure of the first angioembolization” was defined as rebleeding from any cause, encompassing patients who underwent either re-embolization due to rebleeding or surgery due to rebleeding.
Results No significant differences were found between the interventional radiologists and the trauma surgeon in terms of re-embolization due to rebleeding, surgery due to rebleeding, or the overall failure rate of the first angioembolization. Mortality and morbidity rates were also similar between the two groups. In a multivariable logistic regression analysis evaluating failure after the first angioembolization, pelvic embolization emerged as the sole significant risk factor (adjusted odds ratio, 3.29; 95% confidence interval, 1.05–10.33; P=0.041). Trauma surgeon–performed angioembolization was not deemed a significant risk factor in the multivariable logistic regression model.
Conclusions Trauma surgeons, when equipped with the necessary endovascular skills and experience, can safely perform angioembolization. To further improve quality control, an enhanced training curriculum for trauma surgeons is warranted.
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Summary
- Epidemiology and outcomes of patients with penetrating trauma in Incheon Metropolitan City, Korea based on National Emergency Department Information System data: a retrsopective cohort study
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Youngmin Kim, Byungchul Yu, Se-Beom Jeon, Seung Hwan Lee, Jayun Cho, Jihun Gwak, Youngeun Park, Kang Kook Choi, Min A Lee, Gil Jae Lee, Jungnam Lee
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J Trauma Inj. 2023;36(3):224-230. Published online December 21, 2022
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DOI: https://doi.org/10.20408/jti.2022.0055
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- Purpose
Patients with penetrating injuries are at a high risk of mortality, and many of them require emergency surgery. Proper triage and transfer of the patient to the emergency department (ED), where immediate definitive treatment is available, is key to improving survival. This study aimed to evaluate the epidemiology and outcomes of patients with penetrating torso injuries in Incheon Metropolitan City.
Methods Data from trauma patients between 2014 and 2018 (5 years) were extracted from the National Emergency Department Information System. In this study, patients with penetrating injuries to the torso (chest and abdomen) were selected, while those with superficial injuries were excluded.
Results Of 66,285 patients with penetrating trauma, 752 with injuries to the torso were enrolled in this study. In the study population, 345 patients (45.9%) were admitted to the ward or intensive care unit (ICU), 20 (2.7%) were transferred to other hospitals, and 10 (1.3%) died in the ED. Among the admitted patients, 173 (50.1%) underwent nonoperative management and 172 (49.9%) underwent operative management. There were no deaths in the nonoperative management group, but 10 patients (5.8%) died after operative management. The transferred patients showed a significantly longer time from injury to ED arrival, percentage of ICU admissions, and mortality. There were also significant differences in the percentage of operative management, ICU admissions, ED stay time, and mortality between hospitals.
Conclusions Proper triage guidelines need to be implemented so that patients with torso penetrating trauma in Incheon can be transferred directly to the regional trauma center for definitive treatment.
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Summary
- A case report of field amputation: the rescue of an entrapped patient through the "doctor car" system
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Byungchul Yu, Gil Jae Lee, Min A Lee, Kang Kook Choi, Jihun Gwak, Youngeun Park, Yong-Cheol Yoon, Jayun Cho, Seung Hwan Lee, Jungnam Lee
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J Trauma Inj. 2022;35(Suppl 1):S27-S30. Published online June 15, 2022
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DOI: https://doi.org/10.20408/jti.2022.0012
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- In certain circumstances, invasive procedures such as creation of a surgical airway, insertion of a chest drain, intraosseous puncture, or amputation in the field are necessary. These invasive procedures can save lives. However, emergency medical service teams cannot perform such procedures according to the law in Korea. The upper arm of a 29-year-old male patient was stuck in a huge machine and the emergency medical service team could not rescue the patient. A doctor-car team was dispatched to the scene and the team performed the filed amputation to extricate the patient. He was brought to the trauma center immediately and underwent formal above-elbow amputation. Here we describe a case of field amputation to rescue a patient through a “doctor car” system, along with a literature review.
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Summary
- Major Causes of Preventable Death in Trauma Patients
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Youngeun Park, Gil Jae Lee, Min A Lee, Kang Kook Choi, Jihun Gwak, Sung Youl Hyun, Yang Bin Jeon, Yong-Cheol Yoon, Jungnam Lee, Byungchul Yu
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J Trauma Inj. 2021;34(4):225-232. Published online July 29, 2021
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DOI: https://doi.org/10.20408/jti.2020.0074
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11,746
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Abstract
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- Purpose
Trauma is the top cause of death in people under 45 years of age. Deaths from severe trauma can have a negative economic impact due to the loss of people belonging to socio-economically active age groups. Therefore, efforts to reduce the mortality rate of trauma patients are essential. The purpose of this study was to investigate preventable mortality in trauma patients and to identify factors and healthcare-related challenges affecting mortality. Ultimately, these findings will help to improve the quality of trauma care.
Methods
We analyzed the deaths of 411 severe trauma patients who presented to Gachon University Gil Hospital regional trauma center in South Korea from January 2015 to December 2017, using an expert panel review.
Results
The preventable death rate of trauma patients treated at the Gachon University Gil Hospital regional trauma center was 8.0%. Of these, definitely preventable deaths comprised 0.5% and potentially preventable deaths 7.5%. The leading cause of death in trauma patients was traumatic brain injury. Treatment errors most commonly occurred in the intensive care unit (ICU). The most frequent management error was delayed treatment of bleeding.
Conclusions
Most errors in the treatment of trauma patients occurred in early stages of the treatment process and in the ICU. By identifying the main causes of preventable death and errors during the course of treatment, our research will help to reduce the preventable death rate. Appropriate trauma care systems and ongoing education are also needed to reduce preventable deaths from trauma.
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Summary
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Citations
Citations to this article as recorded by
- Effects of Transport to Trauma Centers on Survival Outcomes Among Severe Trauma Patients in Korea: Nationwide Age-Stratified Analysis
Hakrim Kim, Kyoung Jun Song, Ki Jeong Hong, Jeong Ho Park, Tae Han Kim, Stephen Gyung Won Lee Journal of Korean Medical Science.2024;[Epub] CrossRef - Progressive Reduction in Preventable Mortality in a State Trauma System Using Continuous Preventable Mortality Review to Drive Provider Education: Results of Analyzing 1,979 Trauma Deaths from 2015 to 2022
Charles D Mabry, Benjamin Davis, Michael Sutherland, Ronald Robertson, Jennifer Carger, Deidre Wyrick, Terry Collins, Austin Porter, Kyle Kalkwarf Journal of the American College of Surgeons.2024; 238(4): 426. CrossRef - Emergency department laparotomy for patients with severe abdominal trauma: a retrospective study at a single regional trauma center in Korea
Yu Jin Lee, Soon Tak Jeong, Joongsuck Kim, Kwanghee Yeo, Ohsang Kwon, Kyounghwan Kim, Sung Jin Park, Jihun Gwak, Wu Seong Kang Journal of Trauma and Injury.2024; 37(1): 20. CrossRef - Angioembolization performed by trauma surgeons for trauma patients: is it feasible in Korea? A retrospective study
Soonseong Kwon, Kyounghwan Kim, Soon Tak Jeong, Joongsuck Kim, Kwanghee Yeo, Ohsang Kwon, Sung Jin Park, Jihun Gwak, Wu Seong Kang Journal of Trauma and Injury.2024; 37(1): 28. CrossRef - Nomogram for predicting in-hospital mortality in trauma patients undergoing resuscitative endovascular balloon occlusion of the aorta: a retrospective multicenter study
Byungchul Yu, Jayun Cho, Byung Hee Kang, Kyounghwan Kim, Dong Hun Kim, Sung Wook Chang, Pil Young Jung, Yoonjung Heo, Wu Seong Kang Scientific Reports.2024;[Epub] CrossRef - Preventable trauma deaths in the Western Cape of South Africa: A consensus-based panel review
Julia Dixon, Shaheem de Vries, Chelsie Fleischer, Smitha Bhaumik, Chelsea Dymond, Austin Jones, Madeline Ross, Julia Finn, Heike Geduld, Elmin Steyn, Hendrick Lategan, Lesley Hodsdon, Janette Verster, Suzan Mukonkole, Karlien Doubell, Navneet Baidwan, Nee PLOS Global Public Health.2024; 4(5): e0003122. CrossRef - Prolonged time to recovery and its predictors among trauma patients admitted to the intensive care units in comprehensive specialized hospitals in Northwest Ethiopia: a multicenter retrospective follow-up study, 2022
Mengistu Abebe Messelu, Temesgen Ayenew, Tesfa Sewunet Alamneh, Tiruye Azene Demile, Aster Tadesse Shibabaw, Asnake Gashaw Belayneh Frontiers in Medicine.2024;[Epub] CrossRef - The characteristics and clinical outcomes of trauma patients transferred by a physician-staffed helicopter emergency medical service in Korea: a retrospective study
Myung Jin Jang, Woo Sung Choi, Jung Nam Lee, Won Bin Park Journal of Trauma and Injury.2024; 37(2): 106. CrossRef - Evaluation of Current and Future Medical Staff Knowledge on the Course of Trauma Patient Management
Anna Dąbrowska, Wiktoria Malik, Dorota Czachor, Weronika Jarych, Anna Wściślak, Zuzanna Świąder, Łucja Komisarczyk, Piotr Pałczyński Cureus.2024;[Epub] CrossRef - A Deployable Viscoelastic Coagulation Monitor Enables Point-of-Care Assessment of Coagulopathy in Swine With Polytrauma
Teryn R Roberts, Isabella Garcia, Ivan Slychko, Heidi J Dalton, Andriy I Batchinsky Military Medicine.2024;[Epub] CrossRef - Analysis of mortality over 7 years in a mature trauma center: evolution of preventable mortality in severe trauma patients
Sarah Guigues, Jean Cotte, Jean-Baptiste Morvan, Henry de Lesquen, Bertrand Prunet, Mathieu Boutonnet, Nicolas Libert, Pierre Pasquier, Eric Meaudre, Julien Bordes, Michael Cardinale European Journal of Trauma and Emergency Surgery.2023; 49(3): 1425. CrossRef - Incidence and predictors of mortality among adult trauma patients admitted to the intensive care units of comprehensive specialized hospitals in Northwest Ethiopia
Mengistu Abebe Messelu, Ambaye Dejen Tilahun, Zerko Wako Beko, Hussien Endris, Asnake Gashaw Belayneh, Getayeneh Antehunegn Tesema European Journal of Medical Research.2023;[Epub] CrossRef - Characteristics and Clinical Outcomes of Elderly Patients with Trauma Treated in a Local Trauma Center
Kwanhoon Park, Geonjae Cho, Sungho Lee, Kang Yoon Lee, Ji Young Jang Journal of Acute Care Surgery.2023; 13(1): 13. CrossRef - An Artificial Intelligence Model for Predicting Trauma Mortality Among Emergency Department Patients in South Korea: Retrospective Cohort Study
Seungseok Lee, Wu Seong Kang, Do Wan Kim, Sang Hyun Seo, Joongsuck Kim, Soon Tak Jeong, Dong Keon Yon, Jinseok Lee Journal of Medical Internet Research.2023; 25: e49283. CrossRef - Preventable Death Rate of Trauma Patients in a Non-Regional Trauma Center
Kwanhoon Park, Wooram Choi, Sungho Lee, Kang Yoon Lee, Dongbeen Choi, Han-Gil Yoon, Ji Young Jang Journal of Acute Care Surgery.2023; 13(3): 118. CrossRef - TiME OUT: Time-specific Machine-learning Evaluation to Optimize Ultra-massive Transfusion
Courtney H. Meyer, Jonathan Nguyen, Andrew ElHabr, Nethra Venkatayogi, Tyler Steed, Judy Gichoya, Jason D. Sciarretta, James Sikora, Christopher Dente, John Lyons, Craig M. Coopersmith, Crystal Nguyen, Randi N. Smith Journal of Trauma and Acute Care Surgery.2023;[Epub] CrossRef - Nine year in-hospital mortality trends in a high-flow level one trauma center in Italy
Elisa Reitano, Roberto Bini, Margherita Difino, Osvaldo Chiara, Stefania Cimbanassi Updates in Surgery.2022; 74(4): 1445. CrossRef - Decision support by machine learning systems for acute management of severely injured patients: A systematic review
David Baur, Tobias Gehlen, Julian Scherer, David Alexander Back, Serafeim Tsitsilonis, Koroush Kabir, Georg Osterhoff Frontiers in Surgery.2022;[Epub] CrossRef - Flat Inferior Vena Cava on Computed Tomography for Predicting Shock and Mortality in Trauma: A Meta-Analysis
Do Wan Kim, Hee Seon Yoo, Wu Seong Kang Diagnostics.2022; 12(12): 2972. CrossRef - Model for Predicting In-Hospital Mortality of Physical Trauma Patients Using Artificial Intelligence Techniques: Nationwide Population-Based Study in Korea
Seungseok Lee, Wu Seong Kang, Sanghyun Seo, Do Wan Kim, Hoon Ko, Joongsuck Kim, Seonghwa Lee, Jinseok Lee Journal of Medical Internet Research.2022; 24(12): e43757. CrossRef - Thoracic injuries in trauma patients: epidemiology and its influence on mortality
Andrea Lundin, Shahzad K. Akram, Lena Berg, Katarina E. Göransson, Anders Enocson Scandinavian Journal of Trauma, Resuscitation and .2022;[Epub] CrossRef
- The Management of Open Pelvic Fractures: A Report of 2 Cases
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Byungchul Yu, Giljae Lee, Min A Lee, Kangkook Choi, Jihun Gwak, Youngeun Park, Yong-Cheol Yoon, Jungnam Lee
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J Trauma Inj. 2020;33(4):269-274. Published online June 2, 2020
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DOI: https://doi.org/10.20408/jti.2020.008
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17,595
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Abstract
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Open pelvic fractures are rare, but pose challenges for trauma surgeons due to their high morbidity and mortality. Generally, early death results from uncontrolled exsanguination and late death is related to pelvic sepsis. Therefore, management of these injuries should prioritize hemostasis and contamination control starting in the initial phase of treatment. We report two cases of unstable open pelvic fractures with perineal wounds that were managed successfully.
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Summary
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Citations
Citations to this article as recorded by
- Open Pelvic Fractures with a Faringer I Zone Injury: a Set of 3 Case Reports Treated in 2020
J POMETLOVÁ, V JEČMÍNEK, R JEČMÍNKOVÁ Acta chirurgiae orthopaedicae et traumatologiae Ce.2022; 89(2): 164. CrossRef
- Case Series of Zone III Resuscitative Endovascular Balloon Occlusion of the Aorta in Traumatic Shock Patients
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Byungchul Yu, Gil Jae Lee, Kang Kook Choi, Min A Lee, Jihun Gwak, Youngeun Park, Jung Nam Lee
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J Trauma Inj. 2020;33(3):162-169. Published online September 30, 2020
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DOI: https://doi.org/10.20408/jti.2020.0031
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4,233
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- Purpose
There is increasing evidence in the literature regarding resuscitative endovascular balloon occlusion of the aorta (REBOA) globally, but few cases have been reported in Korea. We aimed to describe our experience of successful Zone III REBOA and to discuss its algorithm, techniques, and related complications.
Methods
We reviewed consecutive cases who survived from hypovolemic shock after Zone III REBOA placement for 4 years. We reviewed patients’ baseline characteristics, physiological status, procedural data, and outcomes.
Results
REBOA was performed in 44 patients during the study period, including 10 patients (22.7%) who underwent Zone III REBOA, of whom seven (70%) survived. Only one patient was injured by a penetrating mechanism and survived after cardiopulmonary resuscitation. All patients underwent interventions to stop bleeding immediately after REBOA placement.
Conclusions
This case series suggests that Zone III REBOA is a safe and feasible procedure that could be applied to traumatic shock patients with normal FAST findings who receive a chest X-ray examination at the initial resuscitation.
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Summary
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Citations
Citations to this article as recorded by
- On the Feasibility of Using REBOA Technology for the Treatment of Patients with Polytrauma
A. I. Zhukov, N. N. Zadneprovsky, P. A. Ivanov, L. S. Kokov Russian Sklifosovsky Journal "Emergency Medical Ca.2024; 13(1): 14. CrossRef
- Isolated Dissection of the Celiac Artery after Blunt Trauma: A Case Report and Review of Literature
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Ahram Han, Jihun Gwak, Gangkook Choi, Jae Jeong Park, Byungchul Yu, Gil Jae Lee, Jin Mo Kang
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J Trauma Inj. 2017;30(4):220-226. Published online December 30, 2017
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DOI: https://doi.org/10.20408/jti.2017.30.4.220
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6,612
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Abstract
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Traumatic dissection of the celiac artery without aortic dissection is a rare event. Here we describe two cases of celiac artery dissection after blunt abdominal trauma managed conservatively without surgical or endovascular intervention.
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Summary
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Citations
Citations to this article as recorded by
- Isolated celiac artery injury: Brief report, review of literature, and suggested grading guidelines
Kanani Fahim, Neeman Uri, Hashavia Eyal, Timor Idit, Soffer Dror, Shimonovich Shachar Trauma.2024; 26(4): 360. CrossRef - Endovascular Stenting in a Rare Case of Multiple Spontaneous Visceral Arterial Dissections
Jacxelyn Moran, Naveen Galla, Mona Ranade Vascular and Endovascular Surgery.2021; 55(3): 269. CrossRef - Evaluation of isolated abdominal visceral artery dissection with multi-scale spiral computed tomography: a retrospective case series
Qizhou He, Fei Yu, Yajun Fu, Bin Yang, Ran Huo, Rong Xian, Shulan Liu, Kali Liang, Guangcai Tang Journal of Cardiothoracic Surgery.2021;[Epub] CrossRef - Diagnosis and treatment of isolated celiac artery dissection following blunt trauma: A case report
Tohru Ishimine, Takahiro Ishigami, Kohei Chida, Kyohei Kawasaki, Naoki Taniguchi, Toshiho Tengan International Journal of Surgery Case Reports.2021; 89: 106617. CrossRef - Retrospective Analysis and Systematic Review of Isolated Traumatic Dissections of the Celiac Artery
Jens Birkl, Thomas Kahl, Henryk Thielemann, Sven Mutze, Leonie Goelz Annals of Vascular Surgery.2020; 66: 250. CrossRef - Traumatic dissection of the coeliac artery and splenic injury following blunt trauma
Bobby Vincent Li, Ramesh Damodaran Prabha, Maruthi Narra, Hung Nguyen BMJ Case Reports.2019; 12(8): e229405. CrossRef - Symptomatic Isolated Celiac Artery Dissection following Blunt Trauma
Sang Bong Lee, Hyuk Jae Jung, Jae Hun Kim Journal of Acute Care Surgery.2019; 9(2): 76. CrossRef
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