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Successful minimally invasive management using transcatheter arterial embolization in a hemodynamically stable elderly patient with mesenteric vascular injury in a hybrid emergency room system in Korea: a case report
So Ra Ahn, Joo Hyun Lee, Sang Hyun Seo, Chan Yong Park
J Trauma Inj. 2023;36(4):435-440.   Published online July 25, 2023
DOI: https://doi.org/10.20408/jti.2023.0018
  • 1,646 View
  • 20 Download
AbstractAbstract PDF
Mesenteric injury occurs rarely in cases associated with blunt abdominal trauma. Despite its low incidence, mesenteric injury can lead to fatal outcomes such as hypovolemic shock due to hemoperitoneum or sepsis due to intestinal ischemia, or perforation-related peritonitis. For mesenteric injuries, especially those involving massive bleeding, intestinal ischemia, and perforation, the standard treatment is surgery. However, in the case of operative management, it should be borne in mind that there is a possibility of complications and mortality during and after surgery. The usefulness of transcatheter arterial embolization (TAE) is well known in solid organs but is controversial for mesenteric injury. We present a 75-year-old man with mesenteric injury due to blunt abdominal trauma. Initial abdominal computed tomography showed no hemoperitoneum, but a mesenteric contusion and pseudoaneurysm with a diameter of 17 mm were observed near the origin of the superior mesenteric artery. Since there were no findings requiring emergency surgery such as free air or intestinal ischemia, it was decided to perform nonoperative management with TAE using microcoils in hybrid emergency room system. TAE was performed successfully, and there were no complications such as bleeding, bowel ischemia, or delayed bowel perforation. He was discharged on the 23rd day after admission with percutaneous catheter drainage for drainage of mesenteric hematoma. The authors believe that treatment with TAE for highly selected elderly patients with mesenteric injuries has the positive aspect of minimally invasive management, considering the burden of general anesthesia and the various avoidable intraoperative and postoperative complications.
Summary
Non-Operative Management with Angioembolization of Grade IV and V Renal Injuries in a Hybrid Emergency Room System
So Ra Ahn, Sang Hyun Seo, Joo Hyun Lee, Chan Yong Park
J Trauma Inj. 2021;34(3):191-197.   Published online September 30, 2021
DOI: https://doi.org/10.20408/jti.2021.0034
  • 3,188 View
  • 85 Download
  • 1 Citations
AbstractAbstract PDF

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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Citations

Citations to this article as recorded by  
  • 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

J Trauma Inj : Journal of Trauma and Injury