• Journal of Trauma and Injury
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• 제30권4호
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• pp.238-241
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• 2017

A 52-year-old man experienced blunt trauma upon falling from a height of 40 m while trying to repair the elevator. The patient's systolic blood pressure and hemoglobin levels were 60 mmHg and 7.0 g/dL, respectively, upon admission. A large volume of bloody discharge was observed in the open wound of the perianal area and sacrum. A computed tomography scan revealed an open comminuted sacral fracture with multiple contrast blushes. He underwent emergency laparotomy. Both internal iliac artery ligations were performed to control bleeding from the pelvis. Protective sigmoid loop colostomy was performed because of massive injury to the anal sphincters and pelvis. Pad packing was performed for a sacral open wound and perineal wound at the prone position. After resuscitation of massive transfusion, he underwent the second operation 2 days after the first operation. The pad was removed and the perineal and sacral open wounds were closed. After the damage-control surgery, he recovered safely. In this case, the hemodynamically unstable, open comminuted sacral fracture was treated safely by internal iliac artery ligation with pad packing.

• Tuberculosis and Respiratory Diseases
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• 제40권6호
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• pp.714-718
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• 1993

기관기관지골형성증(Tracheobronchopathia Osteoplastica, TPO)는 기관 및 기관지의 점막하부에서 연골성 혹은 골성 돌출 병변의 형태를 나타내는 결절이 기관 후벽의 막성부위를 제외한 기관지 전부위에서 발생 되는 특징을 가진 질환으로 매우 드물게 보고되고 있다. 그 원인은 아직 밝혀지지 않았으나 만성 기관지 염증성 자극과 결체조직의 화생화 및 기관지 연골의 외연골증과 외골증에 의한다고 하는 등의 가설이 있다. 기관지내시경상 매우 특징적인 염주 혹은 자갈모양의 다발성 결절을 관찰할 수 있으며 대증적인 치료외에 특별한 치료가 없다. 기관지폐쇄가 있을 경우 내시경적 제거를 시도 해 볼 수 있으나 기도 폐쇄가 심할수록 예후가 좋지않다. 저자등은 늑막삼출을 동반한 44세된 남자환자에서 기관지내시경과 전산화 단층촬영과 기관지 내시경 조직검사로 확진된 기관기관지골형성증 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• 대한영상의학회지
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• 제83권5호
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• pp.1121-1127
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• 2022

임신 중 심부자궁내막증의 증상은 대부분 호전되는 것으로 알려져 있다. 그러나 심부자궁내막증과 관련하여 자궁동맥의 가성동맥류, 난소 또는 자궁동맥의 파열 및 탈락막화가 진행된 병변에 의한 복강내 출혈과 같은 심각한 산과적 합병증이 임신후반기에 드물게 보고되었다. 특히, 심부자궁내막증에 발생한 탈락막화가 진행될 경우 파열 및 출혈로 인한 심각한 모체/태아의 합병증이 발생할 수 있어 정확한 진단을 하고 임신 중 상태를 집중 감시하는 것이 필요하다. 그러나 이러한 경우는 매우 드물어 잘 알려져 있지 않으며, 저자들이 아는 한, 현재까지 보고된 심부자궁내막증에 의한 대량출혈은 모두 복강내출혈이 발생한 경우였다. 저자들은 임신 중 직장질부위 심부자궁내막증의 탈락막화가 진행되고 커지면서 질강내로 노출된 병변과 임신 후반기 병변에서 자연히 발생한 대량 질출혈의 증례를 보고하고자 한다.

• Journal of Chest Surgery
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• 제38권10호
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• pp.714-716
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• 2005

우측심장이 매우 확장되어 있는 경우 정중흉골 재절개는 대량출혈의 위험성을 내포하고 있음을 고려해야 한다. 일차 수술에서 정중흉골절개를 통하여 수술했던 환자에서 우측개흉은 삼첨판막에 쉽고 안전하게 접근할 수 있는 방법이다.

• 대한골관절종양학회지
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• 제12권1호
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• pp.89-94
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• 2006

신경초종이 오래되어서 퇴행성 변화를 일으키면 이를 퇴행성 신경초종이라고 명칭하며, 드물게 보고되고 있다. 혈관주변의 초자화, 출혈, 석회화, 낭성 괴사, Antoni A 구역의 축소, 핵의 변형 등의 퇴행성 변화가 나타날 수 있으며, 이러한 퇴행성 변화로 인해 육종 등으로 잘못 진단되기 쉽다. 본원에서는 75세 남자 환자의 하퇴부에서 광범위한 출혈과 혈종, 낭성 변화, 석회화, Antoni A 구역의 축소 등의 퇴행성 변화가 진행된 퇴행성 신경초종을 경험하였기에 문헌적 고찰과 함께 이를 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제40권6호
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• pp.450-454
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• 2006

The incidence of vertebral artery injury during the anterior approach to the cervical spine is rare, but potentially lethal. The authors describe two cases of vertebral artery injury during anterior cervical decompression surgery. In the first case, infection was the cause of the vertebral artery injury. During aggressive irrigation and pus drainage, massive bleeding was encountered, and intraoperative direct packing with hemostatic agents provided effective control of hemorrhage. Ten days after surgery, sudden neck swelling and mental deterioration occurred because of rebleeding from a pseudoaneurysm. In the second case, the vertebral artery was injured during decompression of cervical spondylosis while drilling the neural foramen. After intraoperative control of bleeding, the patient was referred to our hospital, and a pseudoaneurysm was detected by angiography four days after surgery. Both pseudoaneurysms were successfully occluded by an endovascular technique without any neurological sequelae. Urgent vertebral angiography, following intraoperative control of bleeding by hemostatic compression in cases of vertebral artery injury during anterior cervical decompression, should be performed to avoid life-threatening complications. Prompt recognition of pseudoaneurysm is mandatory, and endovascular treatment can be life saving.

• Journal of Trauma and Injury
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• 제33권3호
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• pp.170-174
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• 2020

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is considered an emerging adjunct therapy for profound hemorrhagic shock, as it can maintain temporary stability until definitive repair of the injury. However, there is limited information about the use of this procedure in children. Herein, we report a case of REBOA in a pediatric patient with blunt trauma, wherein the preoperative deployment of REBOA played a pivotal role in damage control resuscitation. A 7-year-old male patient experienced cardiac arrest after a motor vehicle accident. After 30 minutes of cardiopulmonary resuscitation, spontaneous circulation was achieved. The patient was diagnosed with massive hemoperitoneum. REBOA was then performed under ongoing resuscitative measures. An intra-aortic balloon catheter was deployed above the supraceliac aorta, which helped achieved permissive hypotension while the patient was undergoing surgery. After successful bleeding control with small bowel resection for mesenteric avulsion, thorough radiologic evaluations revealed hypoxic brain injury. The patient died from deterioration of disseminated intravascular coagulation. Although the patient did not survive, a postoperative computed tomography scan revealed neither remaining intraperitoneal injury nor peripheral ischemia correlated with the insertion of a 7-Fr sheath. Hence, REBOA can be a successful bridge therapy, and this result may facilitate the further usage of REBOA to save pediatric patients with non-compressible torso hemorrhage.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제23권1호
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• pp.115-120
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• 2020

Klippel-Trenaunay syndrome (KTS) is a rare disorder characterized by a triad of abnormal bone and soft tissue growth, the presence of a port-wine stain, and venous malformations. Gastrointestinal (GI) manifestations of KTS are relatively common and generally do not cause significant problems. However, persistence can lead to chronic GI blood loss or even massive bleeding in rare cases. The majority of the severe GI manifestations associated with KTS present as vascular malformations around the GI tract and exposed vessels can lead to serious bleeding into the GI tract. Herein, we report a case of a 16-year-old boy with severe iron deficiency anemia who was previously misdiagnosed as hemorrhoid due to small amount of chronic bleeding. The actual cause of chronic GI bleeding was from an uncommon GI manifestation of KTS as rectal polyposis.

• Tuberculosis and Respiratory Diseases
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• 제52권5호
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• pp.545-549
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• 2002

임신시에 발생한 폐동정맥기형은 드문 질환으로 유전성 출혈성 모세혈관확장증과 같이 유전적으로 동반되어 나타날 수 있는 질환이다. 저자들은 임신시에 발생한 호흡곤란과 흉부방사선촬영상의 종괴를 주소로 내원한 환자에서 발견된 폐동정맥기형 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• 대한두경부종양학회지
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• 제33권1호
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• pp.85-89
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• 2017

A 62-year-old female patient had goiter for twenty years. She visited out-patient clinic with a hoarse voice and intermittent breathing difficulties. About protruding 15cm sized mass located the anterior neck and right vocal cord paralysis was observed. Preoperative CT scan was strongly suspected of thyroid gland cancer and cervical lymph node metastasis. Therefore, fine needle aspiration test was performed and surgical treatment was planned with the histopathologic results (papillary thyroid carcinoma). Surgery was performed with total thyroidectomy, bilateral cervical lymph node dissection, and right selective nodal lymph node dissection (level II-V). During operation right thyroid seemed to be adherent to surrounding tissue and the blood vessels were extremely engorged. There was hypotensive crisis because of intraoperative excessive bleeding. However it was managed by repetitive transfusion. The operation was completed without abnormalities. She underwent 4 times of bleeding control operation due to postoperative bleeding. After complications were improved, we are currently undergoing out-patient follow up without morbidity.