- The Management of Lupus Thrombocytopenia in Poly Trauma Patient
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Jin Bong Ye, Young Hoon Sul, Seung Je Go, Jung Hee Choi, Joong Suck Kim
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J Trauma Inj. 2017;30(2):59-62. Published online June 30, 2017
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DOI: https://doi.org/10.20408/jti.2017.30.2.59
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- 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, 101×103/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.
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- Pelvic Bone Fracture with Preperitoneal Hemorrhage
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Joong Suck Kim, Young Hoon Sul, Seung Je Go, Jin Bong Ye, Sang Soon Park, Gwan Woo Ku, Yeong Cheol Kim
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J Trauma Inj. 2015;28(4):272-275. Published online December 31, 2015
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DOI: https://doi.org/10.20408/jti.2015.28.4.272
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- Pelvic bone fracture with unstable vital signs is a life-threatening condition demanding proper diagnosis and immediate treatment. Unlike long bones, the pelvic bone is a three dimensional structure with complex holes and grooves for vessels and nerves. Because of this complexity, a pelvic bone fracture can lead to complicated and serious bleeding.
We report a case of a fifty-year-old male suffering from a pelvic bone fracture due to a fall. An imaging study showed fractures of both the superior and the inferior ramus of the pubic bone, with contrast extravasation underneath them, resulting in a large preperitoneal hematoma. He was sent for angiography, which revealed a hemorrhage from a branch of the left obturator artery. Embolization was done with a glue and lipiodol mixture. The patient recovered without complication, and was discharged at four weeks after admission.
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- Arteriovenous Fistula between Renal Artery and Inferior Vena Cava following Penetrating Abdominal Trauma; A Case Report
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Joong Suck Kim, Seung Je Go, Ji Dae Kim, Young Hoon Sul, Jin Bong Ye, Sang Soon Park, Gwan Woo Ku, Yeong Cheol Kim
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J Trauma Inj. 2015;28(4):262-265. Published online December 31, 2015
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DOI: https://doi.org/10.20408/jti.2015.28.4.262
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- An arteriovenous fistula (AVF) from the renal artery following a penetrating abdominal trauma is not common. We report the case of a 19-year-old male who presented with a knife stab wound in the right upper quadrant. Due to unstable vital signs and to the protrusion of the mesentery through the stab wound, providing definite evidence of peritoneal violation, an emergent exploratory laparotomy was carried out. There were injuries at the proximal transverse mesocolon and the second portion of the duodenum, with bile leakage. There was also a mild amount of retroperitoneal hematoma near the right kidney, without signs of expansion or pulsation. The mesocolon and the duodenum were repaired. After the operation, abdominal computerized tomography (CT) was performed, which revealed contrast from the right renal artery shunting directly into the vena cava. Transcatheter arterial embolization with a coil and vascular plug was performed, and the fistula was repaired. The patient recovered completely and was discharged without complication. For further and thorough evaluation of an abdominal trauma, especially one involving the retroperitoneum, a CT scan is recommended, when possible, either prior to surgery or after surgery when the patient is stabile. Furthermore, a lateral retroperitoneal hematoma and an AVF after a penetrating trauma may not always require exploration. Sometimes, it may be safely treated non-operatively or with embolization.
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- Clinical Analysis of TEVAR in Blunt Thoracic Aortic Injury
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Gwan Woo Ku, Jin Ho Choi, Min Suk Choi, Sang Soon Park, Young Hoon Sul, Seung Je Go, Jin Bong Ye, Joong Suck Kim, Yeong Cheol Kim, Jung Joo Hwang
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J Trauma Inj. 2015;28(4):232-240. Published online December 31, 2015
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DOI: https://doi.org/10.20408/jti.2015.28.4.232
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Thoracic aortic injury is a life-threatening injury that has been traditionally treated by using surgical management. Recently, thoracic endovascular aortic repair (TEVAR) has been conducted pervasively as a better alternative treatment method. Therefore, this study will focus on analyzing the outcome of TEVAR in patients suffering from a blunt thoracic aortic injury.
METHODS
Of the blunt thoracic aortic injury patients admitted to Eulji University Hospital, this research focused on the 11 patients who had received TEVAR during the period from January 2008 to April 2014.
RESULTS
Seven of the 11 patients were male. At the time of admission, the mean systolic pressure was 105.64+/-24.60 mm Hg, and the mean heart rate was 103.64+/-20.02 per minute. The median interval from arrival to repair was 7 (4, 47) hours. The mean stay in the ICU was 21.82+/-16.37 hours. In three patients, a chimney graft technique was also performed to save the left subclavian artery. In one patient, a debranching of the aortic arch vessels was performed. In two patients, the left subclavian artery was totally covered. In one patient whose proximal aortic neck length was insufficient, the landing zone was extended by using a prophylactic left subclavian artery to left common carotid artery bypass before TEVAR. There were no operative mortalities, but a patient who was covered of left subclavian artery died from ischemic brain injury. Complications such as migration, endovascular leakage, collapse, infection and thrombus did not occur.
CONCLUSION
Our short-term outcomes of TEVAR for blunt thoracic aorta injury was feasible. Left subclavian artery may be sacrificed if the proximal landing zone is short, but several methods to continue the perfusion should be considered.
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Summary
- Pericardial Tamponade following Perihepatic Gauze Packing for Blunt Hepatic Injury
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Jin Bong Ye, Young Hoon Sul, Seung Je Go, Oh Sang Kwon, Joong Suck Kim, Sang Soon Park, Gwan Woo Ku, Min Koo Lee, Yeong Cheol Kim
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J Trauma Inj. 2015;28(3):211-214. Published online September 30, 2015
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DOI: https://doi.org/10.20408/jti.2015.28.3.211
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- The primary and secondary survey was designed to identify all of a patient's injuries and prioritize their management. However 15 to 22.3% of patient with missed injuries had clinically significant missed injuries. To reduce missed injury, special attention should be focused on patients with severe anatomical injury or obtunded. Victims of blunt trauma commonly had multiple system involvement. Some reports indicate that inexperience, breakdown of estalished protocol, clinical error, and restriction of imaging studies may be responsible for presence of missed injury. The best way of reducing clinical significant of missed injuries was repeated clinical assessment.
Here we report a case of severe blunt hepatic injury patient and pericardial injury that was missed in primary and secondary survey. After damage control surgery of hepatic injury, she remained hemodynamically unstable. Further investigation found cardiac tamponade during intensive care. This was managed by pericardial window operation through previous abdominal incision and abdominal wound closure was performed.
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- Wound Probing in Neck Trauma Patients
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Jin Bong Ye, Young Hoon Sul, Yun Su Mun, Seung Je Go, Oh Sang Kwon, Gwan Woo Ku, Min Koo Lee
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J Trauma Inj. 2015;28(3):198-201. Published online September 30, 2015
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DOI: https://doi.org/10.20408/jti.2015.28.3.198
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- Neck trauma is a relatively uncommon but can be a life-threatening injury. Several guidelines for neck trauma is established to recommend a proper management such as no clamping of bleeding vessels, no probing of wounds, Trendelenberg position for preventing venous air embolism. Here, we present a regretful case of 49-year-old man with neck trauma presenting undesired bleeding after probing of wound, and then discuss about treatment guildeline for neck trauma with a review.
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