• Journal of Chest Surgery
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• v.23 no.1
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• pp.95-106
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• 1990

Between May 1979 and April 1989, 213 patients with esophageal injuries visited the Department of the Thoracic and cardiovascular surgery Department, Yonsei University College of Medicine. There were 159 non perforated esophageal injuries accompanied by hematemesis, and 54 perforated esophageal injuries. The causes of non perforated esophageal injuries were Mallory-Weise Syndrome [%], corrosive esophagitis [54], esophageal carcinoma [4], foreign bodies [2], sclerotherapy due to esophageal varices [3]. The causes of perforated esophageal injuries were esophageal anastomosis[13], malignancies[17], esophagoscopy or bougienage[5], chest trauma[5], foreign bodies[5], paraesophageal surgery[3], others[6] In esophageal perforation due to foreign bodies, esophagoscopy or bougienage, there were 6 cervical esophageal perforations and 9 thoracic esophageal perforations. There were no mortalities in the treatment of the cervical esophageal perforations and 5 deaths resulted in the treatment of 9 thoracic esophageal perforations. And four of six patients with thoracic esophageal perforations died in the initiation of treatment over 24 hours, after trauma. There were another 12 deaths in the patients with chest trauma, malignancies or chronic inflammation except esophageal injuries due to foreign bodies or instruments during the hospital stay or less than 30 days after esophageal injuries. One patient with esophageal carcinoma died due to bleeding and respiratory failure after irradiation. Another patient with esophago gastrostomy due to esophageal carcinoma died of sepsis due to EG site leakage. One patient with a mastectomy due to breast cancer followed by irradiation died of sepsis due to an esophagopleural fistula. Two patients with Mallory-Weiss syndrome died; of hemorrhagic shock in one and of respiratory failure due to massive transfusion in the other. One patient with TEF died of respiratory failure and another died of pneumonia and respiratory failure. One patient with esophageal perforation due to blunt chest trauma died of brain damage accompanied with chest trauma.

• Journal of Trauma and Injury
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• v.36 no.4
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• pp.431-434
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• 2023

Severe blunt injuries to isolated solid abdominal viscera have been previously managed nonoperatively; however, management algorithms for simultaneous visceral injuries are less well defined. We report a polytrauma case of a 33-year-old man involved in a motorbike collision who presented with left-sided chest and abdominal pain. Initial imaging demonstrated multiple solid organ injuries with American Association for the Surgery of Trauma (AAST) grade V splenic injury and complete devascularization of the left kidney. The patient underwent urgent angioembolic coiling of the distal splenic artery with successful nonoperative management of simultaneous grade V solid organ injuries.

• Journal of Chest Surgery
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• v.31 no.3
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• pp.298-303
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• 1998

Computerized tomography(CT) is an effective technique in the initial evaluation of the abdomen and head following blunt trauma. To evaluate the efficacy of CT of the thorax, a retrospective study comparing early thoracic CT scanning with initial chest roentgenogram (CXR) was carried out on 134 patients with blunt trauma on the chest. Among 134 patients, 45 patients had normal initial chest roentgenogram and 24 patients showed normal CT findings. Sensitivities of diagnosing pneumothorax and pleural effusion by CXR were low (46.2 and 62.9% respectively), whereas 71.4%(45/63) of patients had thoracostomy only by CXR. Although sometimes abused, CT of the thorax is effective in the initial diagnosis.

• Journal of Trauma and Injury
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• v.30 no.4
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• pp.166-172
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• 2017

Purpose: Thoracic traumas represent 10-15% of all traumas and are responsible for 25% of all trauma mortalities. Traumatic cardiac injury (TCI) is one of the major causes of death in trauma patients, rarely present in living patients who are transferred to the hospital. TCI is a challenge for trauma surgeons as it provides a short therapeutic window and the management is often dictated by the underlying mechanism and hemodynamic status. This study is to describe our experiences about emergency cardiac surgery in TCI. Methods: This is a retrospective clinical analysis of patients who had undergone emergency cardiac surgery in our trauma center from January 2014 to December 2016. Demographics, physiologic data, mechanism of injuries, the timing of surgical interventions, surgical approaches and outcomes were reviewed. Results: The number of trauma patients who arrived at our hospital during the study period was 9,501. Among them, 884 had chest injuries, 434 patients were evaluated to have over 3 abbreviated injury scale (AIS) about the chest. Cardiac surgeries were performed in 18 patients, and 13 (72.2%) of them were male. The median age was 47.0 years (quartiles 35.0, 55.3). Eleven patients (61.1%) had penetrating traumas. Prehospital cardiopulmonary resuscitations (CPR) were performed in 4 patients (22.2%). All of them had undergone emergency department thoracotomy (EDT), and they were transferred to the operating room for definitive repair of the cardiac injury, but all of them expired in the intensive care unit. Most commonly performed surgical incision was median sternotomy (n=13, 72.2%). The majority site of injury was right ventricle (n=11, 61.1%). The mortality rate was 22.2% (n=4). Conclusions: This study suggests that penetrating cardiac injuries are more often than blunt cardiac injury in TCI, and the majority site of injury is right ventricle. Also, it suggests prehospital CPR and EDT are significantly responsible for high mortality in TCI.

• Journal of Chest Surgery
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• v.29 no.2
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• pp.208-212
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• 1996

From 1990 to 1994, 10 patients were treated for tracheobronchial injury due to blunt trauma. 7 injuries resulted from motor vehicle accident. Common presenting signs included subcutaneous emphysema, dyspnea and hemoptysis. The most common radiologic findings were pneumothorax, pneumomediastinum and hemothorax. The fiberoptic bronchoscopy was highly accurate method for the diagnosis. The operation method is simple closure except one patien underwent right pneumonectomy. One patient died because of respiratory distress and 9 patients recovered uneventfully and returned to normal activity. Early recognition and proper treatment of tracheobronchial injury is important.

• Journal of Chest Surgery
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• v.40 no.1 s.270
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• pp.79-82
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• 2007

Tracheobronchial rupture due to blunt chest trauma is an uncommon injury although the incidence is increasing. Early diagnosis and primary repair of tracheobronchial rupture not only restore a normal lung function but also avoid the difficulties and complications associated with delayed diagnosis and repair We present one case of the tracheal transsection caused by traffic accident. Patient suffered from progressive dyspnea, subcutaneous emphysema on the neck and anterior chest wall and tension pneumothorax at both sides were noted. Although both closed thoracostomy were done, massive air leakage through the chest tube continued and subcutaneous emphysema spread to the anterior abdominal wall and scrotum and the degree of dyspnea aggravated. With the impression of tracheobronchial injury, we performed the emergency operation. Preoperative bronchoscopy at the operation room was proceeded, which revealed the trachea was near totally transsected in transverse direction. Operation was performed through collar incisiion on the anterior neck, and the trachea was anastomosed with 4-0 $Vicryl^{(R)}$ interruptedly. Postoperative course were uneventful and patient discharged without any complications.

• Journal of Chest Surgery
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• v.31 no.6
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• pp.604-609
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• 1998

Trauma to the thorax represents a significant portion of injuries seen in an inner-city emergency room. Although most of these patients may be sucessfully managed without thoracotomy, a certain percentage requires operative intervention either immediately or within several hours. 126 records of patients who had early thoracotomy for chest trauma from March 1986, to June 1997, in the Department of Thoracic and Cardiovascular Surgery in Masan Samsung General Hospital were reviewed. There were 96 males and 30 females whose ages ranged from 4 to 72 years, with a mean age of 32.8 years. The modes of injury were as follows : stab wounds, 55 cases(44%), blunt trauma, 70 cases(55%), and gunshot wound, 1 case(1%). Immediate operation was performed in 105 cases(84%) and delayed operation in 21 cases(16%). Indications that operation was necessary were hemorraging and shock in 66 cases(52%), cardiac tamponade in 27 cases(21%), and rupture of the diaphragm in 33 cases(27%). Most of these patients were sucessfully treated but 21 cases were resulted in death. The mortality rate was 16.6% and common causes of death were irreversible shock and hypoxia.

• Journal of Chest Surgery
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• v.34 no.3
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• pp.264-269
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• 2001

흉부 둔상에 의한 기도와 식도의 동시적 파열상은 매우 드물게 발생되고 있다. 그러나 최그들어 고속 교통사고의 증가와 환자에 대한 응급체계의 발전으로 점차 치험 보고례가 증가되고 있다. 저자들은 흉부의 둔상에 의하여 기도와 식도에 종적으로 긴 파열상을 입은 환자 2례의 치험을 보고한다. 1례는 이전 병원에서 시행한 기관식도 재건술이 실패한 상태에서 전원되어와 2차적으로 식도절제 및 기관재건술을 실시하였으나 사망하였고. 다른 1례는 식도절제 및 기도재건술로 합병증이 없이 생존하였다.

• Journal of Chest Surgery
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• v.19 no.4
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• pp.722-725
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• 1986

Rupture of the main bronchus following closed injury to the chest is a comparatively rare accident. The late recognition of this injury is attended by difficulties in management which may endanger life or expose the patient to distressing months and years of arduous therapy. This case was a 17 year old female who was a high school student. The patient had sustained a crushing injury to her right hemithorax and had been taken to an emergency hospital where right closed thoracostomy had been performed for a tension pneumothorax. She improved following this procedure but massive atelectasis of the right lung developed on the 13th day after trauma and transferred to our hospital. Bronchoscopy disclosed granulation tissue in the right main stem bronchus and end to end anastomosis of the bronchus was performed. Postoperative course was uneventful.

• Journal of Trauma and Injury
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• v.34 no.3
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• pp.208-211
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• 2021

Gallbladder injuries are rare in cases of blunt abdominal trauma and are usually associated with damage to other internal organs. If the physician does not suspect gallbladder injury and check imaging studies carefully, it may be difficult to distinguish a gallbladder injury from gallbladder stone, hematoma, or bleeding. Therefore, in order not to miss the diagnosis, the clinical findings and correlation should be confirmed. In the present case, a 60-year-old male presented to a local trauma center complaining of pain in the upper right quadrant and chest wall following a motor vehicle collision. Abdominal computed tomography (CT) showed a hepatic laceration and hematoma in the parenchyma in segments 4, 5, and 6 and active bleeding in the lumen of the gallbladder. Traumatic gallbladder injuries generally require surgery, but in this case, non-operative management was possible with cautious follow-up consisting of abdominal CT and angiography with repeated physical examinations and hemodynamic monitoring in the intensive care unit.