• Journal of Trauma and Injury
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• 제35권2호
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• pp.139-143
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• 2022

Bacterial infection of skeletal muscle can lead to the formation of abscesses. Primary pyomyositis is typically seen in tropical countries, and Staphylococcus aureus is the commonest causative organism. We present a case of acute adductor magnus muscle abscess (pyomyositis) with spread to adjacent thigh compartments via the perforators without iliopsoas muscle involvement. Due to the involvement of the entire thigh compartment, systemic antibiotic treatment alone was insufficient, whereas surgical drainage improved the clinical picture. The aetiological organism was S. aureus. Herein, we report the case of a patient who had primary pyomyositis, rather than a secondary type, that spread to the posterior and lateral aspect of the thigh through the second and third perforators, which pierce the adductor magnus muscle belly before entering the femur.

• Journal of Trauma and Injury
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• 제35권4호
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• pp.277-281
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• 2022

Craniocerebral gunshot injuries is gradually increasing in the civilian population with a worse prognosis than closed head trauma. We experienced a case of craniocerebral gunshot injury which a bullet penetrating from the submandibular area into the clivus of a patient. The patient did not show any symptom. However, serial laboratory findings showed an increase in blood lead level. We removed foreign bodies without any problems using an endoscopic transnasal transclival approach. Due to the extremely low frequency, guidelines for definitive management of gunshot injuries have not been presented in Korea yet. We introduce our surgical experience of a craniocerebral gunshot injury with an unusual approach for removing intracranial foreign bodies.

• Journal of Trauma and Injury
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• 제36권3호
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• pp.295-297
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• 2023

Penetrating gallbladder injuries are uncommon in the pediatric population. The treatment varies according to the severity of the injury and the patient's hemodynamics. We present the case of an 11-year-old male with an accidental pellet gunshot wound to the right upper abdomen that resulted in a grade III liver laceration and damage to the anterior gallbladder wall. The patient underwent laparoscopic cholecystectomy with drain placement. Postoperative radiography of the surgical specimen confirmed the presence of the pellet in the gallbladder. The patient recovered uneventfully and was discharged home on postoperative day 3. Laparoscopic cholecystectomy is a feasible treatment option for penetrating gallbladder injuries in hemodynamically stable patients.

• Journal of Trauma and Injury
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• 제36권4호
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• pp.454-457
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• 2023

Arterial injuries in the gluteal region caused by a knife are rare but serious, with mortality rates of up to 25%. This case report presents the management of a young male patient admitted to the emergency department in hypovolemic shock, with uncontrollable bleeding from an isolated penetrating gluteal injury. Additionally, the details of the surgical approach employed are discussed.

• Journal of Trauma and Injury
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• 제36권4호
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• pp.458-461
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• 2023

Epiphyseal dislocations and fractures frequently occur in children and adolescents. However, these injuries seldom involve the distal femur, and bilateral cases are even rarer. We present an unusual case of bilateral epiphyseal detachment of the femur in a 21-year-old man who was involved in a traffic accident. Open reduction and fixation surgery were performed 5 days after the incident. The patient experienced favorable progress, with consolidation occurring at 3 months. No lower limb length discrepancies were observed at the 20-month follow-up. In summary, bilateral distal femoral epiphyseal detachment is an uncommon condition that can be effectively treated through surgical intervention.

• Journal of Trauma and Injury
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• 제36권4호
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• pp.411-415
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• 2023

An odontoid process fracture is a serious type of cervical spine injury. This injury is categorized into three types based on the location of the fracture. Severe or even fatal neurological deficits can occur due to associated cord injury, which can result in complete quadriplegia. Computed tomography is the primary diagnostic tool, while magnetic resonance imaging is used to evaluate any associated cord injuries. These injuries can occur either directly from the injury or during transportation to the hospital if mishandled. There are two main treatment approaches: surgical fixation or external nonsurgical fixation, with various types and models of fixation devices available. In this case study, computed tomography follow-up confirmed that external fixation can yield successful results in terms of complete healing, even in cases complicated by other factors that may impede healing, such as pregnancy.

• Journal of Trauma and Injury
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• 제24권2호
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• pp.136-142
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• 2011

Purpose: Blunt pancreatic injury has a high mortality rate, especially if adequate management is delayed. Although many guidelines exist for diagnosis and treatment, there is no consensus to date. Therefore, we analyzed the role of endoscopic retrograde cholangiopancreatography (ERCP) as a diagnostic and therapeutic tool for the treatment of traumatic pancreatic injury. Methods: We retrospectively reviewed the electronic medical records (EMR) database at Asan Medical Center (Seoul, South Korea) to identify all patients diagnosed with trauma to the pancreas between June 2003 and December 2010. Clinical and operative findings, CT (computed tomography) images, and ERCP findings were assessed. Results: A total of 40 patients were evaluated in this study. Of these, 14 patients underwent diagnostic ERCP, and 26 did not. Of the 14 patients who underwent diagnostic ERCP, 5 were found to have normal pancreatic ducts, thereby preventing a needless laparotomy in these patients. Of the patients diagnosed with ductal injury, four were treated with endoscopic intervention, and four underwent an exploratory laparotomy. The remaining patient was treated with radiologic intervention (percutaneous drainage) to manage pancreatic pseudocyst formation. Conclusion: Our findings suggest that ERCP is a beneficial diagnostic and therapeutic modality for the treatment of traumatic pancreatic injury.

• Journal of Trauma and Injury
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• 제25권2호
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• pp.44-48
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• 2012

Purpose: The management of splenic injuries has shifted from a splenectomy to splenic preservation owing to immunity. The purpose of this study was to assess the kinds of management and outcomes through a review of our experience with splenic injuries. Methods: We retrospectively reviewed 47 patients with traumatic splenic injuries using by electronic medical records from Jan. 2007 and Dec. 2011. Splenic injuries were classified according to the American Association for the Surgery of Trauma (AAST) grading system. Results: There were 11 falls, 11 traffic accidents, 10 motorcylcle accidents, 10 pedestrian accidents and 5 abdominal blunt traumas. Low-grade injured patients (${\leq}$ Grade III) were 29 of 43(61.7%), and High-grade injured patients (${\geq}$ Grade IV) were 18 of 43(38.3%). In 34 patients, non-surgical treatment was performed, and 14 patients underwent a splenectomy. There were relatively more high-grade in older patients, and the high-grade-injury group showed need for a transfusion (p=0.002), more need for a splenectomy (p<0.001), a longer mean hospital stay (p=0.036), a longer ICU stay (p=0.045) and more combined organ injury (p=0.036). Conclusion: Conservative treatment should be considered in low-grade-injury patients (${\leq}$ Grade III). A Splenectomy was performed on 56% of the patients with Grade IV injuries, so a splenectomy should be considered carefully in such patients. In patients with a grade V injury, we think surgical treatment may be needed.

• Journal of Trauma and Injury
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• 제33권1호
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• pp.18-22
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• 2020

Purpose: Damage control laparotomy has contributed to improved survival rates for severe abdominal injuries. A large part of severe abdominal injury occurs with a concomitant pelvic bone fracture. The safety and effectiveness of internal fixation of pelvic bone fracture(s) has not been established. The aim of the present study was to evaluate infection risk in the pelvic surgical site in patients who underwent emergent abdominal surgery. Methods: This single-center retrospective observational study was based on data collected from a prospectively maintained registry between January 2015 and June 2019. Patients who underwent laparotomy and pelvic internal fixation were included. Individuals <18 and ≥80 years of age, those with no microbiological investigations, and those who underwent one-stage abdominal surgery were excluded. Comprehensive statistical comparative analysis was not performed due to the small number of enrolled patients. Results: A total of six patients met the inclusion criteria, and the most common injury mechanism was anterior-posterior compression (67%). The average duration of open abdomen was 98 hours (range, 44-98), and the time interval between abdominal closure and pelvic surgery was 98 hours. One patient (16.7%) died due to multi-organ dysfunction syndrome. Micro-organisms were identified in the abdominal surgical site in five patients (83%), with no micro-organisms in pelvic surgical sites. There was no unplanned implant removal. Conclusions: Internal fixation of pelvic bone fracture(s) could be performed in the state of open abdomen, and the advantages of early fixation may countervail the risks for cross contamination.

• Journal of Trauma and Injury
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• 제30권2호
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• pp.25-32
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• 2017

Purpose: The use of computed tomography (CT) to evaluate acute abdominal complaints has increased over the past two decades. We investigated how the clinical practice of patients with intestinal perforation has changed with the increasing use of abdominal CT in the emergency department (ED). Methods: We compared ED arrival to CT time, ED arrival to surgical consultation time, and ED arrival to operation time according to the method of diagnosis from 2003-2004 and 2013-2014. Results: In patients with gastrointestinal perforation, time from ED arrival to CT was shorter ($111.4{\pm}66.2min$ vs. $199.0{\pm}97.5min$, p=0.001) but time to surgical consultation was longer ($135.1{\pm}78.8$ vs. $77.9{\pm}123.7$, p=0.006) in 2013-2014 than in 2003-2004. There was no statistically significant difference in time to operation for perforation confirmed either by plain film or CT between the two time periods. There was no statistically significant difference in length of hospital or ICU stay or mortality between the two groups. Conclusion: With the increasing use of abdominal CT in ED, ED arrival to CT time has decreased and ED arrival to surgical consultation time has increased in gastrointestinal perforation. These changes of clinical performance do not delay ED arrival to operation time or adversely influence patient outcome.