Journal of Trauma and Injury

Management of cardiac trauma and penetrating cardiac injuries with severe hemorrhagic shock: a 5-year experience: Tran Thuc Khang; J Trauma Inj. 2024;37(4):268-275. Published online December 16, 2024; DOI: https://doi.org/10.20408/jti.2024.0063

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Abstract PDF: Purpose
The diagnosis and management of cardiac trauma and penetrating cardiac injuries pose significant challenges in emergency settings due to the rapid onset of life-threatening complications. This paper presents a narrative review to better describe the etiology, presentation, and management of penetrating cardiac trauma, offering insights and experiences related to performing emergency surgery for such cases.
Methods
We compiled cases of traumatic cardiac rupture and penetrating cardiac injuries accompanied by severe hemorrhagic shock that necessitated emergency surgery. Data were collected regarding the type of injury, causative agents, specific clinical features observed during emergency admission, intraoperative parameters, and treatment outcomes.
Results
Twenty-one patients (16 men, 5 women) with cardiac rupture or penetrating cardiac injuries were recorded. All patients presented in severe shock, and six cases (28.6%) experienced cardiac arrest upon arrival in the operating room. Cardiac rupture due to blunt chest trauma occurred in two cases (9.5%), and one case (4.8%) involved right atrial perforation due to complex open chest trauma. Penetrating injuries accounted for cardiac perforation in 18 cases (85.7%). Associated injuries were present in 11 cases (52.4%). The intraoperative mortality rate was 9.5%, and there was one postoperative death on the 11th day due to multiorgan failure.
Conclusions
Cardiac trauma and penetrating injuries are usually fatal unless promptly diagnosed and surgically treated. The timing and rapidity of emergency surgery—often foregoing ancillary tests and administrative procedures—are critical for patient survival. Emergency sternotomy, swift control of bleeding, and aggressive resuscitation are essential operative measures in saving lives. Factors that influence prognosis include the extent of blood loss, duration of cardiac arrest, acid-base imbalances, coagulopathy, multiorgan failure, and postoperative infections.; Summary

Minimally invasive surgery for concomitant pericardial and diaphragmatic rupture after blunt trauma: a case report: Ranti Kenny Maila, Kenny Nyiko Mongwe, Mirza Mohamod Zahir Uddin Bhuiyan; J Trauma Inj. 2025;38(1):51-55. Published online December 16, 2024; DOI: https://doi.org/10.20408/jti.2024.0045

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Abstract PDF: Pericardial rupture with cardiac herniation is a rare injury that occurs following blunt trauma. It is even more unusual to find a pericardial tear associated with diaphragmatic injury after such trauma. Diagnosing this condition through radiologic imaging is challenging. A 51-year-old man was admitted to the emergency department after a wall collapsed on him. He reported overall body discomfort, breathlessness, chest pain, and abdominal discomfort. A plain x-ray revealed haziness in the left thoracic cavity and elevation of the left hemidiaphragm with collapse of the left lung. Additionally, a gastric shadow was seen within the left hemithorax, accompanied by a mediastinal shift to the right. An x-ray of the pelvis displayed fractures at the right sacroiliac joint, left superior pubic ramus, left inferior pubic ramus, and left anterior acetabular with displacement. A computed tomography scan indicated herniation of the stomach, splenic flexure, and spleen, but there was no clear evidence of pericardial laceration. The patient underwent emergency exploratory laparoscopy and thoracoscopy. During the laparoscopy, a significant defect was found in the left hemidiaphragm, along with a pericardial rupture that had led to cardiac herniation and visceral herniation of the stomach, splenic flexure, and spleen through the diaphragmatic tear. The abdominal visceral organs were repositioned into the abdomen, and the diaphragm was repaired. The heart was repositioned, and the pericardial defect was closed using thoracoscopic techniques. Pericardial rupture can be effectively managed using minimally invasive surgery.; Summary

Ruptured uterus in a 36-week pregnant patient with hemorrhagic shock after blunt trauma in Korea: a case report: Sebeom Jeon, Suyoung Park, Soohyun Oh, Jayun Cho; J Trauma Inj. 2023;36(3):281-285. Published online January 18, 2023; DOI: https://doi.org/10.20408/jti.2022.0070

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Abstract PDF: Traumatic uterine rupture is uncommon but can be fatal and life-threatening for both the mother and infant. In addition to complications caused by trauma itself, such as pelvic fracture, gestational complications such as placental abruption, abortion, premature labor, rupture of membranes, maternal death, and stillbirth can occur. In particular, fetuses have been reported to have a high mortality rate in cases of traumatic uterine rupture. A 36-year-old pregnant female patient fell from the fourth floor and was admitted to our trauma center. We observed large hemoperitoneum, pelvic fractures, and spleen laceration, and the fetus was presumed to be located outside the uterus. The pregnant woman was hemodynamically unstable. Although the fetus was stillborn, angioembolization and surgical treatment were properly performed through collaboration with an interventional radiologist, obstetrician, and trauma surgeons. After two orthopedic operations, the patient was discharged after 34 days. This case report suggests the importance of a multidisciplinary approach in the treatment of pregnant trauma patients.; Summary

Celiac Artery Compression After a Spine Fracture, and Pericardium Rupture After Blunt Trauma: A Case Report from a Single Injury: Joongsuck Kim, Hyun Min Cho, Sung Hwan Kim, Seong Hoon Jung, Jeong Eun Sohn, Kwangmin Lee; J Trauma Inj. 2021;34(2):130-135. Published online June 10, 2021; DOI: https://doi.org/10.20408/jti.2020.0053

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Abstract PDF: Celiac artery compression is a rare condition in which the celiac artery is compressed by the median arcuate ligament. Case reports of compression after trauma are hard to find. Blunt traumatic pericardium rupture is also a rare condition. We report a single patient who experienced both rare conditions from a single blunt injury. An 18-year-old woman was brought to the trauma center after a fatal motorcycle accident, in which she was a passenger. The driver was found dead. Her vital signs were stable, but she complained of mild abdominal pain, chest wall pain, and severe back pain. There were no definite neurologic deficits. Her initial computed tomography (CT) scan revealed multiple rib fractures, moderate lung contusions with hemothorax, moderate liver injury, and severe lumbar spine fracture and dislocation. She was brought to the angiography room to check for active bleeding in the liver, which was not apparent. However, the guide wire was not able to pass through the celiac trunk. A review of the initial CT revealed kinking of the celiac trunk, which was assumed to be due to altered anatomy of the median arcuate ligament caused by spine fractures. Immediate fixation of the vertebrae was performed. During recovery, her hemothorax remained loculated. Suspecting empyema, thoracotomy was performed at 3 weeks after admission, revealing organized hematoma without pus formation, as well as rupture of the pericardium, which was immediately sutured, and decortication was carried out. Five weeks after admission, she had recovered without complications and was discharged home.; Summary

Aortoesophageal Fistula after Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injury: Masakazu Nitta, Taro Tamakawa, Natsuo Kamimura, Tadayuki Honda, Hiroshi Endoh; J Trauma Inj. 2019;32(3):172-175. Published online September 30, 2019; DOI: https://doi.org/10.20408/jti.2019.023

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Abstract PDF: Although thoracic endovascular aortic repair (TEVAR) has grown to become the standard of care to treat blunt thoracic aortic injury (BTAI), the long-term effects of TEVAR are still unclear. We here present a 72-year-old man with BTAI due to a traffic accident. He successfully underwent TEVAR and was transferred to another rehabilitation hospital 2 months after the accident. However, 1 month later, he underwent gastroscopy with fever and hematemesis and was diagnosed with aorto-esophageal fistula (AEF). After being re-transferred to Niigata University Medical and Dental Hospital, we tried to convince him to undergo surgical treatment, but he strongly refused. He received palliative care and died due to rupture of the aortic pseudoaneurysm 3 days after the hospital transfer. Fatal complications like AEF may occur after TEVAR, so clinicians need to carefully follow patients who underwent TEVAR.; Summary

Splenic Autotransplantation after Blunt Spleen Injury in Children: Hojun Lee, Byung Hee Kang, Junsik Kwon, John Cook-Jong Lee; J Trauma Inj. 2018;31(2):87-90. Published online August 31, 2018; DOI: https://doi.org/10.20408/jti.2018.31.2.87

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Abstract PDF

Non-operative management has been preferred in blunt spleen injury. Moreover children are more susceptible to post-splenectomy infection, spleen should be preserved if possible. However, splenectomy is inevitable to patients with severe splenic injury. Therefore splenic autotransplantation could be the last chance for preserving splenic function in these patients although efficacy has not proven. Here we reported four cases of children who were underwent splenic autotransplantation successfully after blunt trauma.

Summary

Citations

Citations to this article as recorded by

Stumpfes Bauchtrauma bei Kindern und Jugendlichen: Behandlungskonzepte in der Akutphase
M. C. Schunn, J. Schäfer, F. Neunhoeffer, J. Lieber, J. Fuchs
Die Chirurgie.2023; 94(7): 651. CrossRef

Endovascular Salvage for Traumatic Midthoracic Aortic Rupture with Left Diaphragmatic Injury: Shin-Ah Son, Tak-Hyuk Oh, Gun-Jik Kim, Deok Heon Lee, Kyoung Hoon Lim; J Trauma Inj. 2018;31(2):66-71. Published online August 31, 2018; DOI: https://doi.org/10.20408/jti.2018.31.2.66

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Abstract PDF: Patients with traumatic aortic rupture rarely reach the hospital alive. Even among those who arrive at the hospital alive, traumatic aortic rupture after high-speed motor vehicle accidents leads to a high in-hospital mortality rate and is associated with other major injuries. Here, we report a rare case of descending midthoracic aortic rupture with blunt diaphragmatic rupture. Successful management with emergency laparotomy after an immediate endovascular procedure resulted in a favorable prognosis in this case.; Summary

Traumatic Bilateral Diaphragmatic Ruptures in a 6-Year-Old Boy: Sung Jin Kim, Hyuck Kim, Jun Ho Lee; J Trauma Inj. 2018;31(1):19-23. Published online April 30, 2018; DOI: https://doi.org/10.20408/jti.2018.31.1.19

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Abstract PDF: Traumatic diaphragmatic rupture is an unusual finding that may occur after blunt trauma. In addition, diaphragmatic rupture occurring bilaterally is extremely rare. We experienced a 6-year-old boy with bilateral diaphragmatic rupture, whom survived after surgical treatment by open thoracotomy but, complicated with spinal cord injury discovered after surgery.; Summary

Missed Traumatic Rupture of the Diaphragm: Sang Woo Ryu, Jaykey Chekar, In Ho Yi, Bo Ra Seo, Seong Huek Park, Seong Ju Go; J Trauma Inj. 2017;30(1):16-20. Published online March 31, 2017; DOI: https://doi.org/10.20408/jti.2017.30.1.16

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Abstract PDF

A 48-year-old man came to the emergency department with altered consciousness and hemoperitoneum following a pedestrian traffic accident. He underwent immediate emergency laparotomy, and on the second day, he required craniectomy because of increase of intracranial hemorrhage. A chest radiograph taken 7 days after admission, showed elevation of the right hemi-diaphragm, and follow-up chest CT showed a right-sided rupture of the diaphragm, which was surgically repaired. Rupture of the diaphragm can be easily overlooked and the diagnosis delayed, especially in unstable patients with multiple trauma or altered level of consciousness, as in the case reported here.

Summary

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Identification of Delayed Traumatic Diaphragmatic Injury: A Concise Review
Patricia J. Bartzak
Journal of Trauma Nursing.2022; 29(1): 47. CrossRef

Pseudo-renal Failure Caused by Urinary Bladder Rupture in Multiple Trauma Patient: Jihoon Jang, Kyoung Hoon Lim; J Trauma Inj. 2016;29(4):191-194. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.191

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Abstract PDF: 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.; Summary

Clinical Outcome of a Precontoured Symphysis Pubis Plate with Tension Band Wiring for Traumatic Symphysis Pubis Rupture in Pelvic Fractures: Jeong Moon Lee, Sun Jung Yoon, Myung Sik Park, Kyung Jin Song; J Trauma Inj. 2016;29(1):22-27. Published online March 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.1.22

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Abstract PDF

PURPOSE
The optimal method of fixation of symphysis pubis (SP) diastasis in pelvic ring injuries is still controversial. In this study, we investigated the radiological and the clinical results of a precontoured 4.5-mm symphysis pubis (SP) plate with tension band wiring (TBW) after an anterior pelvic injury in pelvic fractures.
METHODS
We treated 25 patients with traumatic SP diastasis by open reduction and internal fixation with plates and wires. We used a four-hole 4.5-mm precontoured SP plate with a tension band wiring.
RESULTS
Patients with a SP with TBW fixation achieved excellent or good results at final follow-up. Post-operative complications included two (8%) patients with metal work movement. The mean symphyseal width was smaller in 4.5 mm SP plate with TBW during 1-year follow up period.
CONCLUSION
A precontoured symphysis pubis plate (4.5 mm) with figure-of-eight fashion tension band wiring shows favorable radiological results, excellent or good clinical outcome, and a lower complication (hardware failure and revision surgery).

Summary

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Diastasis of Symphysis Pubis In 18-Years Old Female Patient Treated With Conservative Pelvic Binder: Case Report
Trisna Angga Basudana, Mifta Nurmalasari, Austana Nur Hafizh, Muhammad Hanun Mahyuddin
(JOINTS) Journal Orthopaedi and Traumatology Surab.2023; 12(1): 23. CrossRef
Is there a clinical benefit of additional tension band wiring in plate fixation of the symphysis?
Myung-sik Park, Sun-Jung Yoon, Seung-min Choi, Kwanghun Lee
BMC Musculoskeletal Disorders.2017;[Epub] CrossRef

A Case of Neobladder Rupture Following Blunt Trauma: Young Hoon Sul, Moon Haeng Lee, Sang Il Lee, Kwang Sik Cheon, In Sang Song; J Korean Soc Traumatol. 2012;25(3):101-104.

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Abstract PDF: Bladder rupture following blunt trauma is rare, and no neobladder rupture following blunt trauma has yet been reported. We present a case of neobladder rupture following blunt trauma. The patient was a 65-year-old male patient who had been treated for bladder cancer via a radical cystectomy with an orthotopic ileal neobladder four years prior to this admission, and who was admitted to our emergency department due to multiple trauma after a 1.5 m fall. Primary repair was performed for the neobladder rupture.; Summary

Right Diaphragmatic Rupture after Blunt Trauma: Case Report: Ki Hoon Kim, Jin Su Kim, Sung Jin Park, Woon Won Kim, Do Kyun Kang, Ho Gi Min, Yong Han Kim, Cheol Gyu O; J Korean Soc Traumatol. 2012;25(3):87-90.

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Abstract PDF: Blunt diaphragmatic rupture (BDR) is a relatively rare injury and occurs in 0.8% to 7% of all thorocoabdominal blunt trauma. Especially right diaphragmatic rupture after blunt abdominal trauma is a rarer than left. The diagnosis of BDR can be missed while evaluating the multiple trauma patient. Other severe injuries may mask BDR during the primary resuscitation and survey. We experienced two cases of traumatic rupture of right diaphragm, one diagnosed immediately and the other diagnosed delayed. In this paper we present two cases of traumatic diaphragmatic rupture.; Summary

Successful Treatment of Blunt Traumatic Rupture of the Left Atrial Appendage and Pericardium: A Case Report: Kyu Hyouck Kyoung, Sung Ho Jung, Suk Kyung Hong; J Korean Soc Traumatol. 2011;24(2):168-170.

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Abstract PDF: Blunt cardiac rupture is uncommon and is associated with significant mortality. Patients with blunt cardiac rupture usually have combined injury and do not always show signs of cardiac tamponade, which delays the diagnosis of cardiac rupture and increases mortality. We report a case of cardiac rupture diagnosed and treated by using only thoracic exploration based on clinical impression, with radiologic studies, including even echocardiography, showing negative results.; Summary

Delayed Splenic Rupture Following Minor Trauma in a Patient with Underlying Liver Cirrhosis: Kyung Woon Jeung, Byung Kook Lee, Hyun Ho Ryu; J Korean Soc Traumatol. 2011;24(1):52-55.

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Abstract PDF: The spleen is the most frequently injured organ following blunt abdominal trauma. However, delayed splenic rupture is rare. As the technical improvement of computed tomography has proceeded, the diagnosis of splenic injury has become easier than before. However, the diagnosis of delayed splenic rupture could be challenging if the trauma is minor and remote. We present a case of delayed splenic rupture in a patient with underlying liver cirrhosis. A 42-year-old male visited our emergency department with pain in the lower left chest following minor blunt trauma. Initial physical exam and abdominal sonography revealed only liver cirrhosis without traumatic injury. On the sixth day after trauma, he complained of abdominal pain and diarrhea after eating snacks. The patient was misdiagnosed as having acute gastroenteritis until he presented with symptoms of shock. Abdominal sonography and computed tomography revealed the splenic rupture. The patient underwent a splenectomy and then underwent a second operation due to postoperative bleeding 20 hours after the first operation. The patient was discharged uneventfully 30 days after trauma. In the present case, the thrombocytopenia and splenomegaly due to liver cirrhosis are suspected of being risk factors for the development of delayed splenic rupture. The physician should keep in mind the possibility of delayed splenic rupture following blunt abdominal or chest trauma.; Summary

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