• Journal of Chest Surgery
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• v.45 no.4
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• pp.246-250
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• 2012

Background: Although it is rare for the fracture itself to become a life threatening injury in patients suffering from rib fracture, the lives of these patients are occasionally threatened by other associated injuries. Especially, early discovery of patients with rib fracture and intra-abdominal organ injury is extremely important to the prognosis. This study analyzed the link between rib fracture and intra-abdominal injury to achieve improved treatment. Materials and Methods: Among trauma patients that had visited the hospital emergency room from January 2007 to December 2009, a retrospective study was conducted on 453 patients suffering from rib fracture due to blunt trauma. Rib fracture was classified according to location (left, right, and bilateral), and according to level (upper rib fracture [1-2nd rib], middle rib fracture [3-8th rib], and lower rib fracture [9-12th rib]). The researched data was statistically compared and analyzed to investigate the correlation between the location, level, and number of rib fracture and intra-abdominal organ injury. Results: Motor vehicle injury was found to be the most common mechanism of injury with 208 cases (46%). Associated injuries accompanied with rib fracture were generated in 276 cases (61%). Intra-abdominal organ injury was discovered in 97 cases (21%). Liver injury was the most common intra-abdominal injury associated with rib fracture with 39 cases (40%), followed by spleen injury, with 23 cases (23%). Intra-abdominal injury according to level of rib fracture was presented as upper rib fracture in 11 cases (11%), middle rib fracture in 31 cases (32%), and lower rib fracture in 55 cases (57%), thus verifying that intra-abdominal injuries were commonly accompanied in lower rib fractures (p=0.03). In particular, significant increase of intra-abdominal injury was presented in fractures below the 8th rib (p=0.03). The number of intra-abdominal injuries requiring emergency operations was significantly higher in patients with more than 6 rib fractures (p=0.04). Conclusion: Intra-abdominal organ injury is more common in patients with lower rib fracture, especially fractures below the 8th rib. Intra-abdominal organ injuries generated in multiple rib fracture patients with more than 6 fractures significantly higher severity. These cases must be thoroughly inspected and carefully observed as there is possibility of emergency operation.

• Journal of Chest Surgery
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• v.28 no.1
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• pp.47-52
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• 1995

We have experienced 30 cases of traumatic diaphragm injury between January,1988 and August,1993. 30 cases were reviewed and following results were obtained. 1.Sex ratio is 22:8 with male dominance. 2.The 27 cases were due to blunt trauma and other 3 cases were due to penetrating injury. 3.Left side injury was more common than right[24:6 . 4.The most common herniated abdominal organ was the stomach 5.Mortality rate was 27% and its causes were not diaphragmatic injury itself,but other associated multiple organ injury.

• Journal of Trauma and Injury
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• v.22 no.1
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• pp.77-86
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• 2009

Purpose: The appropriate management of traumatic truncal arterial injury is often difficult to determine, particularly if the injury is associated with severe additional truncal lesions. The timing of repair is controversial when patients arrive alive at the hospital. Also, there is an argument about surgery versus stent-graft repair. This study's objective was to evaluate the appropriate method and the timing for treatment in cases of truncal abdominal injury associated with other abdominal lesions. Methods: The medical records at Ajou University Medical Center were reviewed for an 8-year period from January 1, 2001, to December 31, 2008. Twelve consecutive patients, who were diagnosed as having had a traumatic truncal arterial injury, were enrolled in our study. Patients who were dead before arriving at the hospital or were not associated with abdominal organ injury, were excluded. All patients involved were managed by using the ATLS (Advanced Trauma Life Support) guideline. Data on injury site, the timing and treatment method of repair, the overall complications, and the survival rate were collected and analyzed. Results: Every case showed a severe injury of more than 15 point on the ISS (injury severity score) scale. The male-to-female ratio was 9:3, and patients were 41 years old on the average. Sites of associated organ injury were the lung, spleen, bowel, liver, pelvic bone, kidney, heart, vertebra, pancreas, and diaphragm ordered from high frequency to lower frequency. There were 11 cases of surgery, and one case of conservative treatment. Two of the patients died after surgery for truncal organ injury: one from excessive bleeding after surgery and the other from multiple organ failure. Arterial injuries were diagnosed by using computed tomography in every case and 9 patients were treated by using an angiographic stent-graft repair. There were 3 patients whose vessels were normal on admission. Several weeks later, they were diagnosed as having a truncal arterial injury. Conclusion: In stable rupture of the truncal artery, initial conservative management is safe and allows management of the major associated lesions. Stent grafting of the truncal artery is a valuable therapeutic alternative to surgical repair, especially in patients considered to be a high risk for a conventional thoracotomy.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.57-62
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• 2010

Purpose: This study analyzed the characteristics of stable pelvic bone fractures with intra-abdominal solid organ injury. Methods: Medical records were retrospectively reviewed from January 2000 to December 2009 of patients with stable pelvic bone fractures. A stable pelvic bone fracture according to Young's classification is defined as a lateral compression type I and antero-posterior compression type I. Subjects were divided into two groups, one with (injured group) and one without (non-injured group) intra-abdominal solid organ injury, to evaluate the dependences of the characteristics on the presence of an intra-abdominal solid organ injury. Data including demographics, mechanism of injury, initial hemodynamic status, laboratory results, Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), amount of transfusion, admission to intensive care unit (ICU), and mortality were analyzed. Results: The subjects were 128 patients with a mean age of 42 years old, of whom were 67 male patients (52.3%). The injured group had 21 patients(16.4%), and the most frequent injured solid organ was the liver. Traffic accident was the most common mechanism of injury and lateral compression was the most common type of fracture in all groups. Initial systolic blood pressure was lower in the injured group, and the ISS was greater in the injured group. Arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. Transfused packed red blood cells within 24 hours were 8 patients(38.1%) in the injured group and 11 patients(10.3%) in the non-injured group. Conservative treatment was the most common therapeutic modality in all groups. Stay in the ICU was longer in the injured group, and three mortalities occurred. Conclusion: There is a need to decide on a diagnostic and therapeutic plan regarding the possibility of intra-abdominal solid organ injury for hemodynamically unstable patients with stable pelvic bone fractures and for patients with stable pelvic bone fractures along with multiple associated injuries.

• Kidney Research and Clinical Practice
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• v.37 no.4
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• pp.315-322
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• 2018

The high mortality rates associated with acute kidney injury are mainly due to extra-renal complications that occur following distant-organ involvement. Damage to these organs, which is commonly referred to as multiple organ dysfunction syndrome, has more severe and persistent effects. The brain and its sub-structures, such as the hippocampus, are vulnerable organs that can be adversely affected. Acute kidney injury may be associated with numerous brain and hippocampal complications, as it may alter the permeability of the blood-brain barrier. Although the pathogenesis of acute uremic encephalopathy is poorly understood, some of the underlying mechanisms that may contribute to hippocampal involvement include the release of multiple inflammatory mediators that coincide with hippocampus inflammation and cytotoxicity, neurotransmitter derangement, transcriptional dysregulation, and changes in the expression of apoptotic genes. Impairment of brain function, especially of a structure that has vital activity in learning and memory and is very sensitive to renal ischemic injury, can ultimately lead to cognitive and functional complications in patients with acute kidney injury. The objective of this review was to assess these complications in the brain following acute kidney injury, with a focus on the hippocampus as a critical region for learning and memory.

• Journal of Trauma and Injury
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• v.21 no.1
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• pp.28-35
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• 2008

Purpose: This study was conducted to examine the clinical significance IV-contrasted helical abdomen computed tomography (CT) as a diagnostic screening tool to evaluate hollow viscus injury in blunt abdominal trauma patients. Methods: This is a retrospective study encompassing 108 patients, presenting to Korea University Medical Center (KUMC) Emergency Department (ED) from January 2007 to December 2007, with an initial CT finding suggestive of intra-abdominal injury. An initial non-enhanced abdomen CT was taken, followed by an enhanced CT with intravenous contrast. Patients' demographic data, as well as the mechanisms of injury, were inquired upon and obtained, initial diagnosis, as dictated by specialized radiologists, were added to post-operational (post-OP) findings and to additional CT findings acquired during their hospital stays, and all were combined to arrive at final diagnosis. Initial CT findings were further compared with the final diagnosis, yielding values for sensitivity, specificity, and accuracy, as well as positive and negative predictive values. Patients were further divided into two groups, namely, those that underwent operational intervention and those that did not. The initial CT findings of each group were subsequently compared and analyzed. Results: Initial CT scans revealed abnormal findings in a total of 212 cases - solid organ injuries being the most common finding, as was observed in 97 cases. Free fluid accumulation was evident in another 69 cases. Based on the CT findings, 77 cases (71.3%) were initially diagnosed as having a solid organ injury, 20 cases (18.5%) as having a combined (solid organ + hollow viscus) injury, and 11 cases (10.2%), as having an isolated hollow viscus injury. The final diagnosis however, were somewhat different, with only 67 cases (62.0%) attributed to solid organ injury, 31 cases (28.7%) to combined injury (solid + hollow), and 10 cases (9.3%) to hollow viscus injury. The sensitivity (CI 95%) of the initial helical CT in diagnosing hollow viscus injury was 75.6%, and its specificity was 100%. The accuracy in diagnosing hollow viscus injury was also meaningfully lower compared to that in diagnosis of solid organ injury. Among patients initially diagnosed with solid organ injuries, 10 patients (2 from follow-up CT and 8 from post-OP finding) turned out to have combined injuries. A total of 38 patients underwent an operation, and the proportion of initial CT findings suggesting free air, mesenteric hematoma or bowel wall thickening turned out to be significantly higher in the operation group. Conclusion: Abdominal CT was a meaningful screening test for hollow viscus injury, but the sensitivity of abdominal CT was significantly lower in detecting hollow viscus injury as compared to solid organ injury. This calls for special consideration and careful observation by the ED physicians when dealing with cases of blunt abdominal trauma.

• Journal of Trauma and Injury
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• v.25 no.1
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• pp.1-6
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• 2012

Purpose: This study analyzed the characteristics of unstable pelvic bone fractures associated with intra-abdominal solid organ injury. Methods: Medical records were retrospectively collected from January 2000 to December 2010 for patients with unstable pelvic bone fractures. Unstable pelvic bone fracture was defined as lateral compression types II and III, antero-posterior compression types II and III, vertical shear and combined type by young classification. Subjects were divided into two groups, with (injured group) and without (non-injured group) intra-abdominal solid organ injury, to evaluate whether the characteristics of the fractured depended on the presence of associated solid organ injury. Data included demographics, mechanism of injury, initial hemodynamic status, laboratory results, revised trauma score (RTS), abbreviated injury scale (AIS), injury severity score (ISS), amount of transfusion, admission to the intensive care unit (ICU), and mortality. Results: The subjects were 217 patients with a mean age of 44 years and included 134 male patients(61.8%). The injured group included 38 patients(16.9%). Traffic accidents were the most common mechanism of injury, and lateral compression was the most common type of fracture in all groups. The initial blood pressure was lower in the injured group, and the ISS was greater. The arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. The amount of the transfused packed red blood cells within 24 hours was higher in the injured group than the non-injured group. Invasive treatment, including surgery and angiographic embolization, was more common in the injured group, and the stay in the ICU was longer in the injured group. Conclusion: A need exists to decide on a diagnostic and therapeutic plan regarding the possibility of intra-abdominal solid organ injury for hemodynamically unstable patients with unstable pelvic bone fractures and multiple associated injuries.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.261-266
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• 2012

Purpose: Traumatic pancreatic injury is not common in abdominal trauma injury. However, the morbidity and the mortality rates of patients with pancreatic injury, which are related with difficulties of initial assessment, establishment of diagnosis, and treatment are relatively high. The aim of this study is to review our institution's experience and suggest a diagnosis and therapeutic algorithm for use in cases involving traumatic pancreatic injury. Methods: Eighteen(18) patients with blunt pancreatic injury from January, 2004 to October 2012 were included in this study. We analyzed treatment and diagnosis method, other organ injury, treatment interval, hospital stay and complications retrospectively. Results: Nine patients were treated with conservative medication and another nine patients were treated surgically. Complications occurred in nine patients, and one patient died due to intraventricular hemorrhage and subdural hemorrhage with multiple organ failure. Delayed surgery was performed in three cases. The early and delayed surgery groups showed difference in hospital stay and intensive care unit stay. Delayed surgery was associated with a longer hospital stay (p=0.007) than immediate surgery. Conclusion: In blunt pancreatic trauma, proper early diagnosis and prompt treatment are recommended necessity. Based on this review of our experience, we also suggest the adoption of our institution's algorithm for cases involving traumatic pancreatic injury.

• Journal of Trauma and Injury
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• v.28 no.2
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• pp.60-66
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• 2015

Purpose: Cultivator accidents are frequent and often lead to abdomino-perineal organ injury and, if severe, to death. This study presents the clinical characteristics, outcomes, and factors associated with mortality in patients who sustained an abdomino-perineal organ injury in cultivator accidents. Methods: We retrospectively analyzed the records of 53 patients who visited the emergency department of a tertiary hospital with abdomino-perineal organ injuries caused in cultivator accidents from April 2005 to March 2010. Results: All 53 patients had visited other medical institutions before visiting our hospital. Their mean age was $64.0{\pm}11.1$ (range, 20-80) years and 32 (60.4%) patients were 65 or older. The male-to-female ratio was 46:7. The chief complaint was abdominal pain (38 cases, 71.7%). The 53 patients included 41 cultivator operators (77.4%), 11 passengers (20.8%), and 1 passerby (1.9%). The causes of the injuries included a direct impact of the handlebar in 20 cases (37.7%), a rollover in 21 cases (39.6%), a fall in 10 cases (18.9%), and a wheel in two cases (3.8%). Several of the 53 patients had injuries to multiple abdomino-perineal organs, and the injured organs included the liver (23 cases, 26.4%), spleen (16 cases, 18.4%), pancreas (7 cases, 8.0%), small bowel (7 cases, 8.0%), mesentery (6 cases, 6.9%), adrenal gland (5 cases, 5.8%), and other organs. According to the abbreviated injury scale (AIS) dictionary, a thoracic injury was the most frequent co-injury (33 of 53 cases, 62.3%). Abdomino-perineal surgery was performed in 31 cases (58.8%) and angio-embolization was performed for six liver and two kidney injuries. Thirteen patients died (24.5%); all were males. The Injury Severity Scale (ISS) was lower in the survivors ($17.8{\pm}8.5$ vs. $27.0{\pm}16.0$; p=0.010). Conclusion: With the aging of agricultural workers, safety education programs should be implemented. Furthermore, the patient transfer system in agricultural areas must be improved.

• Journal of Trauma and Injury
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• v.22 no.2
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• pp.193-198
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• 2009

Purpose: This study evaluated the characteristics and the prognosis of multiple intraabdominal solid organ injuries, including those to the liver, spleen, and kidney, after blunt trauma. Methods: From January 2001 to March 2009, 39 patients with multiple intraabdominal solid organ injuries, which had been confirmed by contrast-enhanced computed tomography after blunt trauma, were included in this retrospective study. The injury severity score (ISS), abbreviated injury scale (AIS), revised trauma score (RTS), American Association for the Surgery of Trauma (AAST) injury grade of solid organs, initial hemodynamic status, blood gas analysis, blood transfusion, and the mortality were the main outcome measurements. Results: Injured groups were classified into liver/kidney (n=17), liver/spleen (n=4), spleen/kidney (n=13), and liver/kidney/spleen (n=5) groups. Patients were older in the liver/kidney group than in the liver/kidney/spleen group (43 vs 18 years, p=0.023). The initial systolic blood pressures tended to be lower in the liver/kidney group than in the other groups (84 vs 105, 112, and 114 mmHg, p=0.087). The amounts of 24-hour packed RBC transfusion were 32 units in the liver/kidney group and 4 units in the liver/kidney/spleen group, but the difference was not statistically significant. Differences were found in neither the RTS, ISS, and AIS for head, chest, abdominal, and pelvic injuries nor the AAST injury grade for solid organ, but injuries to the chest were more severe in the liver/spleen group than in the spleen/kidney group (AIS 4.0 vs 2.8, p=0.028). Conservative treatment was the most frequent applied treatment in all groups. There were 6 mortalities : 3 due to hypovolemia, 2 to sepsis, and 1 to brain injury. Mortalities occurred only in the liver/kidney group. Conclusion: Patients who had intraabdominal solid organ injuries of the liver and the kidney simultaneously, tended to be transfused more at an early time after trauma, to have lower initial systolic blood pressures, and to have a higher mortality.