• Journal of Trauma and Injury
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• v.30 no.2
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• pp.59-62
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• 2017

Lupus thrombocytopenia is a common clinical manifestation in systemic lupus erythematosus (SLE). It may present to clinicians with considerable therapeutic difficulties. We experienced a 40-year-old poly trauma patient with lupus thrombocytopenia who had been treated with immunosuppressive drugs for SLE. She was treated for refractory thrombocytopenia with platelet transfusion, corticosteroid and Intravenous immunoglobulin (IVIG). Fourteen days after admission, her platelet count started to increase, $101{\times}103/ul$ at 16 days after admission. Trauma patients may carry various underlying diseases and thus trauma surgeons should always be aware and ready for peculiar situations.

• Journal of Trauma and Injury
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• v.36 no.4
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• pp.416-420
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• 2023

Blunt intrathoracic tracheal injuries are rare, even among blunt chest trauma patients. An early diagnosis based on a high index of suspicion allows for timely surgical management of potentially fatal airway trauma, thereby improving overall outcomes. Diagnosing these injuries can be difficult due to their nonspecific clinical features and the occasional difficulty in radiologic diagnosis. If a patient exhibits respiratory compromise with difficult ventilation and poor lung expansion, despite the insertion and management of an intercostal drain following high-energy blunt trauma, there should be a heightened suspicion of potential airway trauma. The aim of primary repair is to restore airway integrity and to minimize the loss of pulmonary parenchyma function. This case report discusses the rare clinical presentation of a patient with blunt trauma to the intrathoracic airway, the surgical management thereof, and his overall outcome. Although blunt traumatic injuries of the trachea are extremely rare and often fatal, early surgical intervention can potentially reduce the risk of mortality.

• Journal of Trauma and Injury
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• v.29 no.4
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• pp.191-194
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• 2016

Pseudo-renal failure presents with renal failure characteristics, such as hypercreatininemia and hyperkalemia without a change in glomerular filtration rate or structure of the kidney. Pseudo-renal failure due to trauma is difficult to diagnose, because symptoms are non-specific and other factors may cause hypercreatininemia and hyperkalemia. In a trauma patient, especially one with pelvic injury, the abrupt elevation of potassium, blood urea nitrogen, and creatinine levels without previous medical history is a key feature in the diagnosis of urinary ascites. We report a case of pseudo-renal failure caused by intraperitoneal bladder rupture in a multiple trauma patient.

• Journal of Trauma and Injury
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• v.37 no.1
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• pp.86-88
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• 2024

Misinterpreting radiographic findings can lead to unnecessary interventions and potential patient harm. The urgency required when responding to the compromised health of trauma patients can increase the likelihood of misinterpreting chest x-rays in critical situations. We present the case report of a trauma patient whose skin fold artifacts were mistaken for pneumothorax on a follow-up chest x-ray, resulting in unnecessary chest tube insertion. We hope to help others differentiate between skin folds and pneumothorax on the chest x-rays of trauma patients by considering factors such as location, shape, sharpness, and vascular markings.

• Journal of Trauma and Injury
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• v.33 no.3
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• pp.181-185
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• 2020

Damage control surgery (DCS) is an abbreviated laparotomy procedure that focuses on controlling bleeding to limit the surgical insult. It has become the primary treatment modality for patients with exsanguinating truncal trauma. Herein, we present the case of a 47-year-old woman with liver, kidney, and superior mesenteric vein (SMV) injuries caused by a motor vehicle collision. The patient underwent DCS following resuscitative endovascular balloon occlusion of the aorta (REBOA). In this case report, we discuss the importance of priority setting in DCS for the treatment of multisystem damage of several abdominal organs, particularly when the patient has incurred a combination of major vascular injuries. We also discuss the implications of damage control of the SMV, perihepatic packing, and right-sided medial visceral rotation. Further understanding of DCS, along with REBOA as a novel resuscitation strategy, can facilitate the conversion of uniformly lethal abdominal injuries into rescuable injuries.

• Journal of Trauma and Injury
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• v.33 no.3
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• pp.186-190
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• 2020

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been increasingly used in recent years as a resuscitative adjunct for trauma patients with life-threatening non-compressible torso hemorrhage. By blocking the aorta temporarily with an inflated balloon, REBOA preserves cerebral and coronary perfusion while diminishing exsanguination below the balloon, thereby providing time for resuscitation and definitive bleeding control. When determining the occlusion zone during the REBOA procedure, factors such tortuosity of the aorta, co-occurring minor chest injuries, and the severity of shock must be considered, as well as the main injury site. This paper describes a case of high Zone I REBOA in an elderly patient with a tortuous aorta who had concomitant injuries of the chest and pelvis.

• Journal of Trauma and Injury
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• v.30 no.2
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• pp.33-40
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• 2017

Purpose: The role for minimally invasive surgery in chest trauma is vague, one that recently is more frequently performed, and one attractive option to be considered. Thoracoscopic surgery may improve morbidity, mortality, hasten recovery and shorten hospital stay. Methods: A total of 31 patients underwent video assisted thoracoscopic surgery for the treatment of blunt and penetrating chest trauma from June 9th, 2013 to March 21st, 2016 in Jeju, South Korea. Results: Twenty-three patients were males and eight patients were females. Their ages ranged from 23 to 81 years. The cause of injury was due to traffic accident in 17 patients, fall down in 5 patients, bicycle accident in 2 patients, battery in 2 patients, crushing injury in 2 patients, and slip down, kicked by horse, and stab wound in one patient each. Video assisted thoracoscopic exploration was performed in the 18 patients with flail chest or greater than 3 displaced ribs. The thoracoscopic procedures done were hematoma evacuation in 13 patients, partial rib fragment excision in 9 patients, lung suture in 5 patients, bleeding control (ligation or electrocautery) in 3 patients with massive hemothorax, diaphragmatic repair in two patients, wedge resection in two patients and decortication in 1 patient. There was only one patient with conversion to open thoracotomy. Conclusion: There is a broad range of procedures that can be done by thoracoscopic surgery and a painful thoracotomy incision can be avoided. Thoracoscopic surgery can be done safely and swiftly in the trauma patient.

• Journal of Trauma and Injury
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• v.32 no.2
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• pp.107-110
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• 2019

Bilateral chylothorax due to blunt trauma is extremely rare. We report a 74-year-old patient that developed delayed bilateral chylothorax after falling off a ladder. The patient had a simple 12th rib fracture and T12 lamina fracture. All other findings seemed normal. He was sent home and on the 5th day visited our emergency center at Halla Hospital with symptoms of dyspnea and lower back pain. Computer tomography of his chest presented massive fluid collection in his right pleural cavity and moderate amounts in his left pleural cavity with 12th rib fracture and T11-12 intervertebral space widening with bilateral facet fractures. Chest tubes were placed bilaterally and chylothorax through both chest tubes was discovered. Conservative treatment for 2 weeks failed, and thus, thoracic duct ligation was done by video assisted thoracoscopic surgery. Thoracic duct embolization was not an option. Postoperatively, the patient is now doing well and happy with the results. Early surgical treatment must be considered in the old patient, whom large amounts of chylothorax are present.

• Journal of Trauma and Injury
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• v.28 no.4
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• pp.241-247
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• 2015

Purpose: To evaluate the influence of how the trauma care system is applied on the management of trauma patients. Methods: We divided the patients into a pre-trauma system group and a post-trauma system group according to the time when we began to apply the trauma care system in our institution. We compared the general characteristics, injury severity score, initial response time to the trauma patients, number of preventable deaths, and clinical outcomes between the two groups. Results: The numbers of patients in the pre-trauma system group and the post-trauma system group were 188 and 257, respectively. No differences in the patient's median ages, trauma scores (ISS, RTS, TRISS) and proportions of severe trauma patients (ISS>15) were observed between the two groups. The number and the proportion of patients who were admitted to our hospital were increased in the post-trauma system group. The time interval from trauma CP activation to emergency surgery or angio-embolization, and the patient's time spent in emergency room were shortened in the post-trauma system group. However, the lengths of the ICU stay and the hospital stay, and the number of in-hospital mortalities were not improved in the post-trauma system group. In severe trauma patients (ISS>15), there were no differences between the two groups in the number and the proportion of admitted patients, and the time interval from trauma CP activation to performing a diagnostic and therapeutic procedure was not shortened in the post-trauma system group. Conclusion: Application of the trauma care system has shortened the time between the initial response and patient management. However, this improvement was not enough to result in better clinical outcomes. More trauma physicians, multidisciplinary cooperation, and a well-organized trauma management process will be needed if the maximum efficacy of the trauma system is to be achieved.

• Journal of Trauma and Injury
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• v.36 no.3
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• pp.281-285
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• 2023

Traumatic uterine rupture is uncommon but can be fatal and life-threatening for both the mother and infant. In addition to complications caused by trauma itself, such as pelvic fracture, gestational complications such as placental abruption, abortion, premature labor, rupture of membranes, maternal death, and stillbirth can occur. In particular, fetuses have been reported to have a high mortality rate in cases of traumatic uterine rupture. A 35-year-old pregnant female patient fell from the fourth floor and was admitted to our trauma center. We observed large hemoperitoneum, pelvic fractures, and spleen laceration, and the fetus was presumed to be located outside the uterus. The pregnant woman was hemodynamically unstable. Although the fetus was stillborn, angioembolization and surgical treatment were properly performed through collaboration with an interventional radiologist, obstetrician, and trauma surgeons. After two orthopedic operations, the patient was discharged after 34 days. This case report suggests the importance of a multidisciplinary approach in the treatment of pregnant trauma patients.