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7 "Penetrating wound"
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Original Article
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
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
J Trauma Inj. 2023;36(3):224-230.   Published online December 21, 2022
DOI: https://doi.org/10.20408/jti.2022.0055
  • 1,574 View
  • 47 Download
AbstractAbstract PDF
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.
Summary
Case Reports
Nonoperative management of colon and mesocolon injuries caused by blunt trauma: three case reports
Naa Lee, Euisung Jeong, Hyunseok Jang, Yunchul Park, Younggoun Jo, Jungchul Kim
J Trauma Inj. 2022;35(4):291-296.   Published online September 19, 2022
DOI: https://doi.org/10.20408/jti.2022.0009
  • 1,764 View
  • 39 Download
AbstractAbstract PDF
The therapeutic approach for colon injury has changed continuously with the evolution of management strategies for trauma patients. In general, immediate laparotomy can be considered in hemodynamically unstable patients with positive findings on extended focused assessment with sonography for trauma. However, in the case of hemodynamically stable patients, an additional evaluation like computed tomography (CT) is required. Surgical treatment is often required if prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation are observed. However, immediate intervention in hemodynamically stable patients without indications for surgical treatment remains questionable. Three patients with colon and mesocolon injuries caused by blunt trauma were treated by nonoperative management. At the time of admission, they were alert and their vital signs were stable. Colon and mesocolon injuries, large hematoma, colon wall edema, and/or ischemia were revealed on CT. However, no prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation were observed. In two cases, conservative treatment was performed without worsening abdominal pain or laboratory tests. Follow-up CT showed improvement without additional treatment. In the third case, follow-up CT and percutaneous drainage were performed in considering the persistent left abdominal discomfort, fever, and elevated inflammatory markers of the patient. After that, outpatient CT showed improvement of the hematoma. In conclusion, nonoperative management can be considered as a therapeutic option for mesocolon and colon injuries caused by blunt trauma of selected cases, despite the presence of large hematoma and ischemia, if there are no clear indications for immediate intervention.
Summary
Successful management of a common carotid artery injury using a Pruitt-F3 Carotid Shunt: a case report
Kang Kook Choi, Jayun Cho, Min A Lee, Soo Min Eun, Yang Bin Jeon
J Trauma Inj. 2022;35(Suppl 1):S3-S7.   Published online May 25, 2022
DOI: https://doi.org/10.20408/jti.2021.0032
  • 1,926 View
  • 74 Download
AbstractAbstract PDF
Penetrating neck injuries are a surgical challenge. In particular, penetrating neck injuries associated with carotid artery injuries have a high mortality rate. Overt external hemorrhage is unanimously considered as an indication for surgical exploration. The authors present a case of successful surgical management for a penetrating common carotid artery injury using a Pruitt-F3 Carotid Shunt (LeMaitre Vascular Inc., Burlington, MA, USA) in a 60-year-old male patient who was transferred to the level 1 trauma center due to a metal fragment piercing his neck while working. Active pulsatile bleeding was observed from the 3-cm-long external wound on the anterior neck in zone II. Emergent neck exploration showed near-total transection of the left common carotid artery just below the carotid bifurcation. After a Pruitt-F3 Carotid Shunt was applied to the injured carotid artery as a temporary vascular shunt, artificial graft interposition was performed for the injured common carotid artery. The patient experienced cerebral infarction as a complication caused by ischemia-reperfusion of the common carotid artery but was discharged in a suitable state for rehabilitation therapy.
Summary
Penetrating sacral injury with a metallic pipe: a case report and literature review
Mahnjeong Ha, Kyoung Hyup Nam, Jae Hun Kim, In Ho Han
J Trauma Inj. 2022;35(2):131-138.   Published online May 11, 2022
DOI: https://doi.org/10.20408/jti.2021.0063
  • 2,957 View
  • 65 Download
AbstractAbstract PDF
Other than gunshot injuries, sacral penetrating injuries with a foreign body exiting to the other side are extremely rare. We encountered a case of sacral injury in which a long metallic pipe penetrated from the anus into the lower back of a patient. Since the pelvis contains various organs, management of a penetrating injury requires multidisciplinary treatment involving several medical specialties. Due to the infrequency of this type of injury, there are no definitive guidelines for effective management. We described our experience surgically treating a sacral penetrating injury and conducted a literature review. On this basis, we suggest a surgical strategy for treating this type of injury.
Summary
Traumatic abdominal wall hernia with hemoperitoneum caused by blunt injury: laparoscopic exploration with mini-laparotomy repair. A case report
Euisung Jeong, Hyunseok Jang, Younggoun Jo, Yunchul Park, Naa Lee, Jungchul Kim
J Trauma Inj. 2022;35(1):61-65.   Published online December 23, 2021
DOI: https://doi.org/10.20408/jti.2021.0062
  • 2,643 View
  • 66 Download
  • 1 Citations
AbstractAbstract PDF
Traumatic abdominal wall hernia is a very rare clinical entity. Herein, we report the case of a patient who was transferred from a local clinic to the emergency department because of left lower abdominal pain. Initially, an intra-abdominal hematoma was observed on computed tomography and no extravasation was noted. Conservative treatment was initiated, and the patient’s symptoms were slightly relieved. However, though abdominal pain was relieved during the hospital stay, bowel herniation was suspected in the left periumbilical area. Follow-up computed tomography showed traumatic abdominal wall hernia with hemoperitoneum in the abdomen. We performed a laparoscopic exploration of the injury site and hernia lesion. The anterior abdominal wall hernia was successfully closed.
Summary

Citations

Citations to this article as recorded by  
  • Unique laparoscopic emergency management of traumatic obstructed abdominal wall hernia: A case report and review of literature
    Arwa M Aljuhani, Ghaith A Al Saied, Arjmand Reyaz, Mohammed A Alkahlan, Ibrahim M Aljohani, Muhammed M Abukhater
    International Journal of Abdominal Wall and Hernia.2024;[Epub]     CrossRef
Emergency Repair Using Cervico-median Sternotomy for Cervicothoracic Penetrating Injury
Hyun Joo Lee, Hyun Koo Kim, Young Ho Choi
J Korean Soc Traumatol. 2008;21(2):136-139.
  • 1,315 View
  • 1 Download
AbstractAbstract PDF
A great variety of penetrating injuries is happening due to the increasing population and violence today. An optimal surgical approach is the key factor for successful repair of a complicated penetrating injury. A 23-yearold woman fell down the stairs from the second floor and received cervico-thoracic penetration injury due to a metalic bar. The metalic bar ruptured the right jugular vein and penetrated the left upper and lower lung. Under cervico-median sternotomy, neck vessels were repaired and the left thorax was successfully entered to repair the damaged lung through the mediastinal pleura. With this approach, the patient's position did not need to be changed during operation, while reduced the operation time compared to the conventional approach (cervical incision and standard thoracotomy).
Summary
Original Article
Difference in Management Between Native Koreans and Foreigners with Penetrating Wounds In the Emergency Room
Yong Kwan Kim, Yong Soo Jang, Gu Hyun Kang, Jung Tae Choi, Hoo Jeon, Jin Ho Kim
J Korean Soc Traumatol. 2010;23(2):102-106.
  • 1,181 View
  • 2 Download
AbstractAbstract PDF
PURPOSE
With the increasing numbers of foreign residents in Korea, the need for an emergency medical care system for foreign patients seems to be growing. Sometimes, a foreigner admitted to an emergency room is not treated sufficiently due to the absence of insurance, facility in the Korean language, and a guardian. The management of a foreigner with trauma in the ER is difficult due to various problems such as social and economic status. The purpose of this study was to investigate the current management status of foreigners with penetrating wounds in the emergency room.
METHODS
This study is an analysis of 580 patients that were diagnosed with penetrating wounds in one teaching Hospital from Jan. 1, 2008 to Dec. 31, 2008. We analyzed results according to nationality, alcohol ingestion, intentional or accidental trauma, trauma mechanism, injury severity, management time in the ER, and outcome in the ER.
RESULTS
Of the total 580 patients, 486 patients (83.8%) were native Koreans and 94 patients (16.2%) were foreigners. According to the Revised Trauma Score, the average score of native Korean patients was 7.808, and the average score of foreign patients was 7.638. Of native Korean patients, 22.6% had knife wounds while 38.3% of foreign patients did. Of native Korean patients, 17.3% experienced intentional trauma while 33.0% of the foreign patients did. Of native Korean patients, 22.5% had ingested alcohol while 49.4% of the foreigners had. Of native Korean patients, 10.5% were admitted while 7.6% of the foreign patients were. Of native Korean patients, 14.2% were discharged against medical advice (DAMA), while 18.5% of foreign patients were. Of native Korean patients, 1.2% ran away while 8.7% of the foreign patients did.
CONCLUSION
Stabbing was the most common cause of penetrating wounds in foreigner patients in this study. Intentional trauma was more common in foreigners with penetrating wounds than in native Koreans. The severity was higher in foreigners with penetrating wounds than it was in native Koreans, and patients who ran away or were discharged against medical advice were more commonly foreigners with penetrating wounds. Social insurance or policy is needed for the management of foreigners with penetrating wounds.
Summary

J Trauma Inj : Journal of Trauma and Injury