• Journal of Chest Surgery
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• 제27권8호
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• pp.643-649
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• 1994

We evaluated sixteen patients of traumatic diaphragmatic injuries that we have experienced from Jan. 1987 to Aug 1993. Age was ranged from 6 to 71 years, predominantly in the fourth and fifth decades. 13 were male and 3 were female, a ratio of 4.3: 1. Blunt trauma was develped in 11 [Lt 7, Rt 4], penetrating trauma in 5 [Lt 2, Rt 3]. Preoperative diagnosis of diaphragmatic injury was possible in 8 patients [72.2 %] in blunt trauma, and 1 patient [20 %] in penetrating trauma. 8 cases[54.5%] in blunt trauma, and 4 cases in penetrating trauma were treated within 24 hours,meanwhile, patients treated after 10 days were 3, all by blunt trauma.The repair of 16 cases were performed with thoracic approach in 4 cases, thoracoabdominal approach in 3 cases, and abdominal approach in 9 cases. The herniated organs in thorax were stomach [5], colon [3], liver [2], and pancreas [1]. Postoperative complication were developed in 9cases[56.3%] significantly related with delayed operation time [p < 0.01 ]. Hospital mortality was 12.5 % [2/16], and the causes of death were hypovolemic shock in one and hepatic failure due to portal vein rupture in another.

• Journal of Chest Surgery
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• 제44권1호
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• pp.76-79
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• 2011

Right-sided diaphragmatic rupture is less common and more difficult to diagnose than left-sided lesion. It is rarely combined with the herniation of the abdominal organs into the thorax. High level of suspicion is the key to early diagnosis, and a delay in diagnosis is implicated with a considerable risk of mortality and morbidity. We experienced a case of right-sided diaphragmatic rupture combined with complete avulsion of the right kidney and herniation of the liver into the thoracic cavity.

• Journal of Chest Surgery
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• 제54권1호
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• pp.68-71
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• 2021

A 37-year-old man was transferred to our level I trauma center after a road traffic accident, presenting with right acetabular fracture, multiple rib fractures, epidural hemorrhage, and liver contusion. Severe traumatic tricuspid regurgitation was also discovered during the work-up for surgery. Our initial attempt at acetabular surgery failed when the patient experienced near cardiac arrest during anesthetic induction. It was hence decided that tricuspid valve repair should precede orthopedic surgery. Minimally invasive tricuspid valve repair using the double orifice technique was successfully performed. Subsequently, acetabular surgery was performed and he was discharged 35 days post-trauma without any complications.

• Journal of Trauma and Injury
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• 제29권3호
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• pp.93-97
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• 2016

Hepatic duct confluence injury, which is developed by blunt abdominal trauma, is rare. Conventionally, bile duct injury was treated by surgical intervention. In recent decades, however, there had been an increase in radiologic or endoscopic intervention to treat bile duct injury. In a hemodynamically stable patient, endoscopic intervention is considered as the first-line treatment for bile duct injury. A 40 year-old man was transferred to the emergency department of ${\bigcirc}{\bigcirc}$ trauma center after multiple blunt injuries. Contrast-enhanced abdominal computed tomography performed in another hospital showed a liver laceration with active arterial bleeding, fracture of the sacrum and left inferior pubic ramus, and intraperitoneal bladder rupture. The patient presented with hemorrhagic shock because of intra-peritoneal hemorrhage. After resuscitation, angiographic intervention was performed. After angiographic embolization of the liver laceration, emergency laparotomy was performed to repair the bladder injury. However, there was no evidence of bile duct injury on initial laparotomy. On post-trauma day (PTD) 4, the color of intra-abdominal drainage of the patient changed to a greenish hue; bile leakage was revealed on magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP). Bile leakage was detected near the hepatic duct confluence; therefore, a biliary stent was placed into the left hepatic duct. On PTD 37, contrast leakage was still detected but both hepatic ducts were delineated on the second ERCP. Stents were placed into the right and left hepatic ducts. On PTD 71, a third ERCP revealed no contrast leakage; therefore, all stents were removed after 2 weeks (PTD 85). ERCP and biliary stenting could be effective treatment options for hemodynamically stable patients after blunt trauma.

• Journal of Trauma and Injury
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• 제34권2호
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• pp.130-135
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• 2021

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.

• Journal of Trauma and Injury
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• 제29권2호
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• pp.47-50
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• 2016

Transcatheter arterial embolization (TAE) for blunt hepatic injury in children is not common and is especially rare after damage control surgery (DCS). We report a successful TAE after DCS on a child for massive bleeding from the left hepatic artery due to a motor vehicle accident. The car (a sport utility vehicle) ran over the chest and abdomen of a 4-year-old boy. On arrival, initial vital signs were as follows: blood pressure, 70/40 mmHg; heart rate, 149/min; temperature, $36.7^{\circ}C$; respiratory rate, 38/min. After resuscitation, computed tomography was done, and a suspicious contrast leakage from a branch of the left hepatic artery and a spleen injury (grade V) were found. TAE was performed successfully after DCS for a liver injury.

• Journal of Trauma and Injury
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• 제19권1호
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• pp.21-27
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• 2006

Purpose: The liver is one of the most commonly injured organs by blunt or penetrating abdominal trauma. Patients with liver injury can be treated by using nonoperative or operative management. The aim of this study was to study patients with traumatic liver injury who were treated by using operative management. Methods: Ninety-eight patients with traumatic liver injury underwent surgical treatment from January 1995 to December 2004 at Soonchunhyang University Cheonan hospital. Medical records were reviewed retrospectively, and demographic, clinical, operative, and postoperative datas were collected and analyzed. Results: Among the patients with operative management, the peak incidence was in the third and the fourth decades. The male-to-female ratio was 1.9:1. The most frequent injury mechanism was blunt trauma (85.7%). Abdominal computed tomography was the diagnostic modality used most frequently. Severe liver injury above Grade III was seen in 80.6% of all patients, and long bone fracture was the most common combined injury. Patients were managed by using various techniques, including simple closure, liver resection, and perihepatic packing. Pulmonary complications were the most common postoperative complications (35.7%). the overall mortality rate was 17.3%. Between the survival group and the expired group, the amount of transfusion for the expired group was statistically more than that for the survival group. Conclusion: Operative management is an effective treatment modality for hemodynamically unstable patients with severe traumatic liver injury. The amount of transfusion is a significant prognostic factor for survival.

• Journal of Trauma and Injury
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• 제28권1호
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• pp.34-38
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• 2015

The case of a patient with a transfusion-related acute lung injury (TRALI) to whom extracorporeal membrane oxygenation (ECMO) had been applied is reported. A 55-year-old male injured with liver laceration (grade 3) without chest injury after car accident. He received lots of blood transfusion and underwent damage control abdominal surgery. In the immediate postoperative period, he suffered from severe hypoxia and respiratory acidosis despite of vigorous management such as 100% oxygen with mechanical ventilation, high PEEP and muscle relaxant. Finally, ECMO was applied to the patients as a last resort. Aggressive treatment with ECMO improved the oxygenation and reduced the acidosis. Unfortunately, the patient died of liver failure and infection. TRALI is a part of acute respiratory distress syndrome (ARDS). The use of ECMO for TRALI induced severe hypoxemia might be a useful option for providing time to allow the injured lung to recover.

• Journal of Trauma and Injury
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• 제37권1호
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• pp.28-36
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• 2024

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 Jeju Regional 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.

• Journal of Trauma and Injury
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• 제25권3호
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• pp.72-78
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• 2012

Purpose: Clinical observation and research findings show that acute traumatic coagulopathy (ATC) is a major factor that must be addressed in the early care of severe trauma patients. ATC is associated with increased transfusion requirements and poor clinical outcomes. This study aimed to correlate the early predictable factors of ATC with the outcomes in severe trauma patients. Methods: Retrospective data from the trauma registry on severe trauma patients (Injury Severity Score (ISS) ${\geq}16$) were used to identify variables independently associated with coagulopathy. Univariate associations were calculated, and a multivariable logistic regression analysis was used to determine variables independently associated with ATC. Results: Patients were mostly male, aged $51.9{\pm}17.8$ years, with an injury severity score of $24.1{\pm}12.4$. ATC, as diagnosed in the emergency department (ED), occurred in 17% of the severe trauma patients. Using a multivariable logistic regression analysis, early predictable variables independently associated with ATC were base deficit (odds ratio (OR): 13.03; 95% confidence interval (CI): 3.47-48.93), acute liver injury (OR: 4.24; 95% CI: 1.06-17.00), and transfer from another hospital (OR: 21.00; 95% CI: 3.23-136.60). Conclusion: ATC is associated with mortality in severe trauma patients, and some variables associated with trauma and shock are an independent predictors of ATC. These variables contribute to the early recognition and management of coagulopathy, which may improve the outcome from trauma resuscitation.