Renal injuries occur in more than 10% of patients who sustain blunt abdominal injuries. Non-operative management (NOM) is the established treatment strategy for lowgrade (I–III) renal injuries. However, despite some evidence that NOM can be successfully applied to high-grade (IV, V) renal injuries, it remains unclear whether NOM is appropriate in such cases. The authors report two cases of high-grade renal injuries that underwent NOM after embolization in a hybrid emergency room (ER) system with a 24/7 in-house interventional radiology (IR) team. A 29-year-old male visited Wonkwang University Hospital Regional Trauma Center complaining of right abdominal pain after being hit by a rope. Computed tomography (CT) was performed 16 minutes after arrival, and the CT scan indicated a grade V right renal injury. Arterial embolization was initiated within 31 minutes of presentation. A 56-year-old male was transferred to Wonkwang University Hospital Regional Trauma Center with a complaint of right flank pain. He had initially presented to a nearby hospital after falling from a 3-m height. Thanks to the key CT images sent from the previous hospital prior to the patient’s arrival, angiography was performed within 8 minutes of the patient’s arrival and arterial embolization was completed within 25 minutes. Both patients were treated successfully through NOM with angioembolization and preserved kidneys. Hematoma in the first patient and urinoma in the second patient resolved with percutaneous catheter drainage. The authors believe that the hybrid ER system with an in-house IR team could contribute to NOM and kidney preservation even in high-grade renal injuries.

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• Endovascular embolization of persistent liver injuries not responding to conservative management: a narrative review
  Simon Roh
  Journal of Trauma and Injury.2023; 36(3): 165.     CrossRef

Abdominal wall hematoma (AWH) after blunt trauma is common, and most cases can be treated conservatively. More invasive treatment is required in patients with traumatic AWH if active bleeding is identified or there is no response to medical treatment. Herein, we report a case of endovascular embolization for traumatic subcutaneous AWH. Almost endovascular treatment for AHW is done through the deep inferior epigastric artery. However, in this case, the superficial inferior epigastric artery was the bleeding focus and embolization target. After understanding the vascular system of the abdominal wall, an endovascular approach and embolization is a safe and effective treatment option for AWH.

Splenic injury is a common result of blunt trauma, and bleeding occurs mainly inside the splenic capsule and may leak into the peritoneal space. Herein, we report a case where active bleeding occurred in the splenic artery and only leaked into the extraperitoneal space. This is the first case of this phenomenon in a trauma patient in the English-language literature. Bleeding passed through the peritoneum, leaked into the anterior pararenal space, and continued along the extraperitoneal space to the prevesical space of the pelvis. Therefore, on the initial computed tomography (CT) scan, the bleeding appeared to be in the left paracolic gutter, so we suspected mesenteric bleeding. However, after the CT series was fully reconstructed, we accurately read the scans and confirmed splenic injury with active bleeding. If there had been a suspicion of bowel or mesenteric injury, surgery would have been required, but fortunately surgery could be avoided in this case. The patient was successfully treated with angioembolization.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a novel technique to maintain proximal arterial pressure. It is important to locate the balloon catheter correctly in performing REBOA but it is inaccurate to check the catheter position by external measurement. Even if the position of the catheter is initially confirmed by X-ray, it is difficult to determine the location of the catheter that changes according to various situations. We performed REBOA under real-time fluoroscopy and could maintain the catheter in correct position under various situations.