• Journal of Chest Surgery
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• v.24 no.6
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• pp.579-584
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• 1991

The records of 25 patients with traumatic diaphragmatic injuries seen at Chosun University Hospital from February 1977 to May 1991 were reviewed. We treated 20 male and 5 female patients ranging in age from 6 to 72 years. The diaphragmatic injuries were due to blunt trauma in 19 cases[traffic accident 13, fall down 4, compression injury 2] and penetrating trauma in 6 cases[stab wound 5, gun shot 1]. Most common symptoms were dyspnea[72%], chest pain[56%] and abdominal pain [40%], Chest X-ray were normal in 7 cases[28%] and 22 cases[88%] were diagnosed or suspected as diaphragmatic injuries preoperatively. The repair of 25 cases were performed with thoracic approach in 16 cases, thoracoabdominal approach in 6 cases and abdominal approach in 3 cases. Postoperative complications included atelectasis, wound infection and empyema. there was no postoperative death.

• Journal of Chest Surgery
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• v.26 no.2
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• pp.96-101
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• 1993

Fourteen cases of diaphragmatic hernias surgically treated at the Dept. of Thoracic ＆ Cardiovascular Surgery in Kosin Medical Center from Jan. 1979 to Feb. 1991, were reviewed in this study. This report includ 9 cases of traumatic diaphragmatic hernia, 5 cases of congenital diaphragmatic hernia. Among the traumatic hernias, 5 cases were blunt trauma and 4 cases were penetrating trauma. Five cases of congenital diaphragmatic hernias were presented, including 2 cases of esophageal hiatal hernia, 2 cases of Bochdalek's hernia and a case of Morgagni's hernia. Operation was performed in all patients. Results of all treated cases were excellent.

• Journal of Chest Surgery
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• v.27 no.3
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• pp.255-258
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• 1994

I have experienced with 6 cases traumatic injury of diaphragm from May 1991 to October 1993 at the Youngdong Hospital in Tonghae. This cases included 4 penetrating injuries and 2 nonpenetrating injuries. Associated injuries occurred 4 cases and 2 cases occurred stomach herniation. All cases, operative treatment were done. Result of this treatment cases were good. Complications included 1 early death and only 1 wound infection. Cause of death was related to associated injury.

• Journal of Chest Surgery
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• v.28 no.12
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• pp.1197-1200
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• 1995

Since diaphragmatic injuries are difficult to diagnose, those that missed may present with latent symptoms.Delayed diaphragmatic hernia is very rare and occurs commonly after penetrating or blunt trauma. Recently we had experience with two cases of delayed diaphragmatic hernia after left nephrectomy.They were operated by herniolysis and closure of diaphragm using prosthetic patch[Dura, Dacron through the left thoracotomy. Postoperative courses were uneventful.

• Journal of Chest Surgery
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• v.54 no.1
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• pp.59-64
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• 2021

Background: Diaphragmatic injuries following blunt or penetrating thoraco-abdominal trauma are rare, but can be life-threatening. Rib fractures are the most common associated injury in patients with a traumatic diaphragmatic injury (TDI). We hypothesized that the pattern of rib fracture injuries could dictate the likelihood of acute TDIs. Methods: A retrospective study was carried out between April 2014 and October 2018 to analyze patients with TDIs and rib fractures at a major trauma center in London, United Kingdom. Results: Over the study period, 1,560 patients had rib fractures, of whom 14 had associated diaphragmatic injuries. Left-sided diaphragmatic injuries were found in 8 patients (57%). A significant proportion of the rib fractures were located posterolaterally (44.9%). The highest frequency of fractures was found in ribs 5-10, which accounted for 74% of all the fractures. Ten patients underwent surgery, of whom 7 were diagnosed with a diaphragmatic injury intraoperatively after video-assisted thoracoscopic surgery assessment of the pleural cavity. Two patients died due to severe injuries of other organs and the remaining 2 patients were managed conservatively. Conclusion: Our series of patients demonstrates a relationship between significant rib fractures and diaphragmatic injuries in trauma patients, and the diagnostic difficulties in identifying the condition. We found that the location of the rib fractures and the pattern of injury in patients with TDIs were much lower and posterolateral in the chest wall without a preference for laterality. We suggest using a thoracoscope in patients undergoing chest wall surgery post-trauma to aid in diagnosing this condition.

• Journal of Trauma and Injury
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• v.35 no.3
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• pp.215-218
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• 2022

The rectum is the least frequently injured organ in trauma, with an incidence of about 1% to 3% in trauma cases involving civilians. Most rectal injuries are caused by gunshot wounds, blunt force trauma, and stab wounds. A 46-year-old male patient was crushed between two vehicles while he was working. He was hemodynamically unstable, and the Focused Assessment with Sonography for Trauma showed hemoperitoneum and hemoretroperitoneum; therefore, damage control surgery with pelvic packing was performed. A subsequent whole-body computed tomography scan showed a displaced pelvic bone and sacrum fracture. There was evidence of an anorectal full-thickness laceration and urethral laceration. In second-look surgery performed 48 hours later, the pelvis was stabilized with external fixators, and it was decided to proceed with loop sigmoid colostomy. A tractioned rectal probe with an internal balloon was positioned in order to approach the flaps of the rectal wall laceration. On postoperative day 13, a radiological examination with endoluminal contrast injected from the stoma after removal of the balloon was performed and showed no evidence of extraluminal leak. Rectosigmoidoscopy, rectal manometry, anal sphincter electromyography, and trans-stomic transit examinations showed normal findings, indicating that it was appropriate to proceed with the closure of the colostomy. The postoperative course was uneventful. The optimal management for extraperitoneal penetrating rectal injuries continues to evolve. Primary repair with fecal diversion is the mainstay of treatment, and a conservative approach to rectal lacerations with an internal balloon in a rectal probe could provide a possibility for healing with a lower risk of complications.

• Journal of Trauma and Injury
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• v.29 no.3
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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 Chest Surgery
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• v.22 no.4
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• pp.698-704
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• 1989

We experienced the seven cases of penetrating and non-penetrating cardiac injuries combined with cardiac tamponade from June 1986 to June 1989 at Seoul and Chun-An Hospital of SOONCHUNHYANG medical college. The results were as follows. l. In sex distribution, 7 cases were male. In age distribution, The fourth decades occupied about 58 % of all cases. 2. In mode of injury, 4 cases were stab wounds, 1 case penetration by metallic fragment, 2 cases blunt chest trauma. 3. We routinely checked the CVP with subclavian vein catheterization in case of suspicious cardiac tamponade. Significant increments were showed in 4 cases. 4. Becks triad [low blood pressure, raised central venous pressure, distant heart sound] were recorded in 43 % of the cases with proven tamponades. 5. The sites of injury included RV in 4 cases, LV in 1 case, RA in 1 case and branch of RCA in 1 case. The RV injuries were the most common. 6. Coronary artery damage occurred in 2 cases. LADA was severed in 1 case combined with RV rupture and branch of RCA was torn 1 case. 7. Pericardiocentesis was performed 1 case at another hospital before referring to our hospital. We have never used the procedure because we think that it is potentially dangerous with no clear benefit. 8. Subxyphoid pericardial window was performed in 2 cases of severe cardiac tamponade. We have employed this method to stabilize the patients who had systolic hypotension. 9. Surgical approaches were performed with median sternotomy in 3 cases, thoracotomy in 4 cases. 10. We undertook the simple closure in 6 penetrating cardiac wounds. The removal of impacted metallic fragment was performed under the cardiopulmonary bypass. Simple ligation was performed in 2 cases of coronary artery severance 11. One patient with no sign of life was urgently intubated and undertaken an emergency room thoracotomy on the stretch car without antiseptic preparation. The cardiorrhaphy in 6 cases were performed in the operating theater 12. One patient undertaken emergency room thoracotomy did not survive due to refractory hypovolemic shock. But the remaining 6 patients recovered.

• Journal of the Korean Orthopaedic Association
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• v.55 no.5
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• pp.431-435
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• 2020

Pseudoaneurysm which is usually caused by high energy trauma or penetrating injury results in serious complications if the diagnosis is delayed. The authors experienced a 63-year-old patient who slipped on the stairs with simple contusion and skin laceration. But, he was finally diagnosed with pseudoaneurysm of tibioperoneal trunk of tibial artery on magnetic resonance imaging and 3-dimensional computed tomography angiogram performed in two weeks due to aggravation of the symptoms. To the best of my knowledge, pseudoaneurysm of tibio-peroneal trunk caused by minor blunt trauma has not been reported till now in Korea. So we report this case with a review of the relevant literature.

• Archives of Craniofacial Surgery
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• v.22 no.2
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• pp.99-104
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• 2021

Background: To fight the coronavirus disease 2019 (COVID-19) pandemic, many countries have implemented social distancing and lockdowns. We investigated the changes in the trauma patterns of emergency plastic surgeries in the midst of a pandemic. Methods: A retrospective review of the medical records of all patients treated for emergency plastic surgeries was performed at our hospital in Seoul. We conducted the analysis between March 1 and June 30, 2020, and compared the data obtained with that of the same period in 2019. We also investigated changes in trauma patterns according to the social distancing level from July 2020 to February 2021. Results: There was a total of 800 emergency plastic surgery patients from March to June 2020, which was less than the 981 in the corresponding period in 2019. The proportion of patients aged 7-17 years and ≥ 80 in 2020 showed a significant decrease. In 2020, patients presenting with facial trauma decreased and hand trauma, markedly laceration, increased significantly. In 2020, more injuries happened at home, whereas significantly fewer injuries happened on the streets. In 2020, slipping and sports injury decreased, whereas penetrating injury increased significantly. In the changes observed according to the social distancing level, there were significant differences in age classification, facial open wound, and the mechanism of injury. Conclusion: Social distancing has caused a change in emergency plastic surgeries. To ensure safe and appropriate treatment, strict epidemiologic workup and protective equipment are required.