- Successful Endoscopic Treatment of Hepatic Duct Confluence Injury after Blunt Abdominal Trauma: Case Report
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Chan Ik Park, Sung Jin Park, Sang Bong Lee, Kwang Hee Yeo, Seon Uoo Choi, Seon Hee Kim, Jae Hun Kim, Dong Hoon Baek
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J Trauma Inj. 2016;29(3):93-97. Published online September 30, 2016
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DOI: https://doi.org/10.20408/jti.2016.29.3.93
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- 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 OO 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.
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- Successful Angiographic Embolization of Superficial Circumflex Iliac Artery Rupture Caused by Blunt Abdominal Trauma: A Case Report
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Sang Bong Lee, Sung Jin Park, Kwang Hee Yeo, Ho Hyun Kim, Chan Yong Park, Jae Hun Kim, Chang Wan Kim, Seon Uoo Choi, Seon Hee Kim, Jung Joo Hwang, Hyun Min Cho
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J Trauma Inj. 2015;28(1):39-42. Published online March 30, 2015
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DOI: https://doi.org/10.20408/jti.2015.28.1.39
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- Lat. abdominal wall hematoma with active bleeding is very rare but need prompt bleeding control. We report successful treatment by angiographic embolization of superficial circumflex iliac artery rupture caused by blunt trauma. A 60-year-old woman presented painful, enlarging, lat. abdominal wall mass with ecchymosis caused by blunt abdominal trauma. Contrast leakage of superficial circumflex iliac a. within the lt. ext. oblique m. hematoma was confirmed by abdominal computed tomography. Angiographic embolization was performed successfully. Patient was discharged at 4th day after trauma without complication. Angiographic embolization is important treatment option of lat. abdominal wall hematoma with active bleeding replacing emergency surgery.
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- Delayed Aortic Injury Caused by a Posterior Rib Fracture: A Case Report
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Chang Wan Kim, Seon Uoo Choi, Seon Hee Kim, Jae Hun Kim, Jung Joo Hwang, Hyun Min Cho, Seung Hwan Song, Jeong Su Cho
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J Trauma Inj. 2015;28(1):31-33. Published online March 30, 2015
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DOI: https://doi.org/10.20408/jti.2015.28.1.31
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- Traumatic aortic injury is well recognized as a primary cause of instantaneous death in victims of thoracic blunt trauma presenting with an aortic rupture or dissection, particularly after a deceleration injury. However, a direct aortic injury caused by a fractured rib segment after blunt thoracic trauma is extremely rare. We report the case of a 43-year-old male patient who experienced an aortic injury caused by the sharp edge of a fractured rib after multiple rib fractures due to blunt thoracic trauma.
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