Journal of Trauma and Injury

“Most downloaded” articles are those published within the last 2 years (2021– ). The following are the most frequently downloaded articles from Journal of Trauma and Injury.

Review Article

Endovascular embolization of persistent liver injuries not responding to conservative management: a narrative review: Simon Roh; J Trauma Inj. 2023;36(3):165-171. Published online September 15, 2023; DOI: https://doi.org/10.20408/jti.2023.0040

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Abstract PDF: Trauma remains a significant healthcare burden, causing over five million yearly fatalities. Notably, the liver is a frequently injured solid organ in abdominal trauma, especially in patients under 40 years. It becomes even more critical given that uncontrolled hemorrhage linked to liver trauma can have mortality rates ranging from 10% to 50%. Liver injuries, mainly resulting from blunt trauma such as motor vehicle accidents, are traditionally classified using the American Association for the Surgery of Trauma grading scale. However, recent developments have introduced the World Society of Emergency Surgery classification, which considers the patient's physiological status. The diagnostic approach often involves multiphase computed tomography (CT). Still, newer methods like split-bolus single-pass CT and contrast-enhanced ultrasound (CEUS) aim to reduce radiation exposure. Concerning management, nonoperative strategies have emerged as the gold standard, especially for hemodynamically stable patients. Incorporating angiography with embolization has also been beneficial, with success rates reported between 80% and 97%. However, it is essential to identify the specific source of bleeding for effective embolization. Given the severity of liver trauma and its potential complications, innovations in diagnostic and therapeutic approaches have been pivotal. While CT remains a primary diagnostic tool, methods like CEUS offer safer alternatives. Moreover, nonoperative management, especially when combined with angiography and embolization, has demonstrated notable success. Still, the healthcare community must remain vigilant to complications and continuously seek improvements in trauma care.; Summary

Original Articles

No frequency change of prehospital treatments by emergency medical services providers for traumatic cardiac arrest patients before and after the COVID-19 pandemic in Korea: an observational study: Ju Heon Lee, Hyung Il Kim; J Trauma Inj. 2023;36(3):172-179. Published online August 2, 2023; DOI: https://doi.org/10.20408/jti.2023.0009

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Abstract PDF: Purpose
Out-of-hospital traumatic cardiac arrest (TCA) often has a poor prognosis despite rescue efforts. Although the incidence and mortality of out-of-hospital cardiac arrest have increased, bystander cardiopulmonary resuscitation (CPR) has decreased in some countries during the COVID-19 pandemic. In the prehospital setting, immediate treatment of cardiac arrest is required without knowing the patient’s COVID-19 status. Because COVID-19 is usually transmitted through the respiratory tract, airway management can put medical personnel at risk for infection. This study explored whether on-scene treatments involving CPR for TCA patients changed during the COVID-19 pandemic in Korea.
Methods
This retrospective study used data from emergency medical services (EMS) run sheets in Gangwon Province from January 2019 to December 2021. Patients whose initial problem was cardiac arrest and who received CPR were included. Data in 2019 were classified as pre–COVID-19 and all subsequent data (from 2020 and 2021) as post–COVID-19. Age, sex, possible cause of cardiac arrest, and treatments including airway maneuvers, oropharyngeal airway (OPA) or i-gel insertion, endotracheal intubation (ETI), bag-valve mask (BVM) ventilation, intravenous (IV) line establishment, neck collar application, and wound dressing with hemostasis were investigated.
Results
During the study period, 2,007 patients received CPR, of whom 596 patients had TCA and 367 had disease-origin cardiac arrest (DCA). Among the patients with TCA, 192 (32.2%) were pre–COVID-19 and 404 (67.8%) were post–COVID-19. In the TCA group, prehospital treatments did not decrease. The average frequencies were 59.7% for airway maneuvers, 47.5% for OPA, 57.4% for BVM, and 51.3% for neck collar application. The rates of ETI, i-gel insertion, and IV-line establishment increased. The treatment rate for TCA was significantly higher than that for DCA.
Conclusions
Prehospital treatments by EMS workers for patients with TCA did not decrease during the COVID-19 pandemic. Instead, the rates of ETI, i-gel insertion, and IV-line establishment increased.; Summary

Distally based lateral supramalleolar flap for reconstructing distal foot defects in India: a prospective cohort study: Raja Kiran Kumar Goud, Palukuri Lakshmi, Sanujit Pawde, Madhulika Dharmapuri, Swati Sankar, Sandeep Reddy Chintha; J Trauma Inj. 2023;36(3):217-223. Published online September 18, 2023; DOI: https://doi.org/10.20408/jti.2023.0005

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Abstract PDF: Purpose
Defects involving the ankle and foot are often the result of road traffic accidents. Many such defects are composite and require a flap for coverage, which is a significant challenge for reconstructive surgeons. Various locoregional options, such as reverse sural artery, reverse peroneal artery, peroneus brevis muscle, perforator-based, and fasciocutaneous flaps, have been used, but each flap type has limitations. In this study, we used the distally based lateral supramalleolar flap to reconstruct distal dorsal defects of the foot. The aim of this study was to analyze the efficacy of the flap in reconstructing distal dorsal defects of the foot. The specific objectives were to study the adequacy, reach, and utility of the lateral supramalleolar flap for distal defects of the dorsum of the foot; to observe various complications encountered with the flap; and to study the functional outcomes of reconstruction.
Methods
The distal dorsal foot defects of 10 patients were reconstructed with distal lateral supramalleolar flaps over a period of 6 months at a tertiary care center, and the results were analyzed.
Results
We were able to effectively cover distal foot defects in all 10 cases. Flap congestion was observed in two cases, and minor graft loss was seen in two cases.
Conclusions
The distally based lateral supramalleolar flap is a good pedicled locoregional flap for the coverage of distal dorsal foot and ankle defects of moderate size, with relatively few complications and little morbidity. It can be used as a lifeboat or even substitute for a free flap.; Summary

Thoracolumbar spine fracture patterns, etiologies, and treatment modalities in Jordan: Ahmad Almigdad, Sattam Alazaydeh, Mohammad Bani Mustafa, Mu'men Alshawish, Anas Al Abdallat; J Trauma Inj. 2023;36(2):98-104. Published online April 14, 2023; DOI: https://doi.org/10.20408/jti.2022.0068

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Abstract PDF: Purpose
Spine fractures are a significant cause of long-term disability and socioeconomic burden. The incidence of spine fractures tends to increase with age, decreased bone density, and fall risk. In this study, we evaluated thoracolumbar fractures at a tertiary hospital in Jordan regarding their frequency, etiology, patterns, and treatment modalities.
Methods
The clinical and radiological records of 469 patients with thoracolumbar fractures admitted to the Royal Medical Services from July 2018 to August 2022 were evaluated regarding patients’ age, sex, mechanism of injury, fracture level and pattern, and treatment modalities.
Results
The mean age of patients was 51.24±20.22 years, and men represented 52.3%. Compression injuries accounted for 97.2% of thoracolumbar fractures, and the thoracolumbar junction was the most common fracture location. Falling from the ground level was the most common mechanism and accounted for half of the injuries. Associated neurological injuries were identified in 3.8% of patients and were more common in younger patients. Pathological fractures were found in 12.4% and were more prevalent among elderly patients and women.
Conclusions
Traffic accidents and falling from height were the most common causes of spine fractures in patients younger than 40. However, 70% of spine fractures in women were caused by simple falls, reflecting the high prevalence of osteoporosis among women and the elderly. Therefore, traffic and work safety measures, as well as home safety measures and osteoporosis treatment for the elderly, should be recommended to reduce the risk of spine fractures.; Summary

Treatment results of cardiac tamponade due to thoracic trauma at Jeju Regional Trauma Center, Korea: a case series: Jeong Woo Oh, Minjeong Chae; J Trauma Inj. 2023;36(3):180-186. Published online January 31, 2023; DOI: https://doi.org/10.20408/jti.2022.0061

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Abstract PDF: Purpose
The purpose of this study was to report the treatment results of patients with traumatic cardiac tamponade after the opening of Jeju Regional Trauma Center.
Methods
We analyzed the treatment outcomes of patients with traumatic cardiac tamponade who were treated at Jeju Regional Trauma Center from January 2018 to August 2022.
Results
Seven patients with traumatic cardiac tamponade were treated. The male to female ratio was 1.33:1 (four male and three female patients) and the average age was 60.3±7.2 years. The mechanism of injury was blunt trauma in six cases and penetrating injury in one case. Upon arrival at the emergency department, pericardiostomy was performed in four cases, and an emergency operation was performed in six cases. Pericardiostomy alone was performed in one patient, who had cardiac tamponade due to extrapericardial suprahepatic inferior vena cava rupture. The causes of cardiac tamponade were right atrium appendage rupture in one case, right ventricle rupture in one case, inferior vena cava rupture in two cases, right atrium and left atrium rupture in one case, both atria and left ventricle rupture in one case, and intercostal artery rupture in one case. In three cases, intraoperative cardiopulmonary bypass was required. Two of the seven patients died (mortality rate, 28.5%).
Conclusions
Relatively favorable treatment results were observed for traumatic cardiac tamponade patients after Jeju Regional Trauma Center was established.; Summary

Case Report

Blunt abdominal trauma resulting in pancreatic injury in a pediatric patient in Australia: a case report: Harmanjit Dev, Colin Kikiros; J Trauma Inj. 2023;36(3):310-314. Published online August 24, 2023; DOI: https://doi.org/10.20408/jti.2023.0013

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Abstract PDF: Pancreatic trauma from a blunt injury is fairly uncommon in the pediatric population. Furthermore, such trauma with associated disruption of the pancreatic duct (PD) is even less prevalent and is associated with high morbidity and mortality. Pancreatic injuries in the pediatric population are often missed and hence require a thorough workup in children presenting with any form of abdominal injury. This case report describes a young boy who presented with abdominal pain and did not initially inform medical staff about any injury. For this reason, his initial provisional diagnosis was appendicitis, but he was later found to have transection of the pancreas with injury to the PD on imaging. The management of such injuries in pediatric patients often poses a challenge due to a lack of pediatric physicians trained to perform interventions such as endoscopic retrograde cholangiopancreatography. Furthermore, such interventions carry a higher risk when performed on children due to the smaller size of their pancreatic ducts. As a result, our patient had to be transferred to an adult center to undergo this procedure. Thus, maintaining a high degree of suspicion, along with a detailed history and examination, is crucial for the early diagnosis and management of pancreatic injuries.; Summary

Original Article

Clinical characteristics of patients with the hardware failure after surgical stabilization of rib fractures in Korea: a case series: Na Hyeon Lee, Sun Hyun Kim, Seon Hee Kim, Dong Yeon Ryu, Sang Bong Lee, Chan Ik Park, Hohyun Kim, Gil Hwan Kim, Youngwoong Kim, Hyun Min Cho; J Trauma Inj. 2023;36(3):196-205. Published online September 5, 2023; DOI: https://doi.org/10.20408/jti.2023.0026

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Abstract PDF: Purpose
Surgical stabilization of rib fractures (SSRF) is widely used in patients with flail chests, and several studies have reported the efficacy of SSRF even in multiple rib fractures. However, few reports have discussed the hardware failure (HF) of implanted plates. We aimed to evaluate the clinical characteristics of patients with HF after SSRF and further investigate the related factors.
Methods
We retrospectively reviewed the electronic medical records of patients who underwent SSRF for multiple rib fractures at a level I trauma center in Korea between January 2014 and January 2021. We defined HF as the unintentional loosening of screws, dislocation, or breakage of the implanted plates. The baseline characteristics, surgical outcomes, and types of HF were assessed.
Results
During the study period, 728 patients underwent SSRF, of whom 80 (10.9%) were diagnosed with HF. The mean age of HF patients was 56.5±13.6 years, and 66 (82.5%) were men. There were 59 cases (73.8%) of screw loosening, 21 (26.3%) of plate breakage, 17 (21.3%) of screw migration, and seven (8.8%) of plate dislocation. Nine patients (11.3%) experienced wound infection, and 35 patients (43.8%) experienced chronic pain. A total of 21 patients (26.3%) underwent reoperation for plate removal. The patients in the reoperation group were significantly younger, had fewer fractures and plates, underwent costal fixation, and had a longer follow-up. There were no significant differences in subjective chest symptoms or lung capacity.
Conclusions
HF after SSRF occurred in 10.9% of the cases, and screw loosening was the most common. Further longitudinal studies are needed to identify risk factors for SSRF failure.; Summary

Case Reports

Management of a trauma patient with alcohol withdrawal who developed neuroleptic malignant syndrome in Korea: a case report: Byungchul Yu, Ji Yeon Lee, Yong Beom Kim, Hee Yeon Park, Junsu Jung, Youn Yi Jo; J Trauma Inj. 2023;36(3):249-252. Published online December 20, 2022; DOI: https://doi.org/10.20408/jti.2022.0048

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Abstract PDF: Neuroleptic malignant syndrome (NMS) is a rare but fatal condition, with a high mortality rate. NMS is characterized by altered mental status, fever, myoclonus, autonomic dysfunctions, and elevated creatinine phosphokinase. The clinical manifestations may be confused with alcohol-related symptoms, trauma, sepsis, postoperative agitation, or malignant hyperthermia. A 69-year-old male patient with alcohol withdrawal was admitted to the operating theatre to rule out septic shock due to mesenteric injury after multiple trauma. He was suspected NMS with abrupt increase body temperature to 41.7°C after haloperidol administration. Active cooling and rapid fluid infusion was done during anesthesia. Delayed diagnosis and treatment of NMS lead to catastrophic result. Therefore, if the patient's past medical history is unknown or clinical symptoms develop that are suggestive of NMS, early treatment must be considered.; Summary

Percutaneous screw fixation and external stabilization as definitive surgical intervention for a pelvic ring injury combined with an acetabular fracture in the acute phase of polytrauma in Korea: a case report: Hohyoung Lee, Myung-Rae Cho, Suk-Kyoon Song, Euisun Yoon, Sungho Lee; J Trauma Inj. 2023;36(3):298-303. Published online July 13, 2023; DOI: https://doi.org/10.20408/jti.2023.0002

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Abstract PDF: Unstable pelvic ring injuries are potentially life-threatening and associated with high mortality and complication rates in polytrauma patients. The most common cause of death in patients with pelvic ring injuries is massive bleeding. With resuscitation, external fixation can be performed as a temporary stabilization procedure for hemostasis in unstable pelvic fractures. Internal fixation following temporary external fixation of the pelvic ring yields superior and more reliable stabilization. However, a time-consuming extended approach to open reduction and internal fixation of the pelvic ring is frequently precluded by an unacceptable physiologic condition and/or concomitant injuries in patients with multiple injuries. Conservative treatment may lead to pelvic ring deformity, which is associated with various functional disabilities such as limb length discrepancy, gait disturbance, and sitting intolerance. Therefore, if the patient is not expected to be suitable for additional surgery due to a poor expected physiologic condition, definitive external fixation in combination with various percutaneous screw fixations to restore the pelvic ring should be considered in the acute phase. Herein, we report a case of unstable pelvic ring injury successfully treated with definitive external fixation and percutaneous screw fixation in the acute phase in a severely injured polytrauma patient.; Summary

Pre-Hospital and In-Hospital Management of an Abdominal Impalement Injury Caused by a Tree Branch: So Ra Ahn, Joo Hyun Lee, Keun Young Kim, Chan Yong Park; J Trauma Inj. 2021;34(4):288-293. Published online December 16, 2021; DOI: https://doi.org/10.20408/jti.2021.0051

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Abstract PDF: In South Korea, most patients who visit trauma centers with abdominal injuries have blunt trauma, and penetrating injuries are relatively rare. In extremely rare cases, some patients are admitted with a long object penetrating their abdomen, and these injuries are referred to as abdominal impalement injuries. Most cases of impalement injuries lead to fatal bleeding, and patients often die at the scene of the accident. However, patients who survive until reaching the hospital can have a good prognosis with optimal treatment. A 68-year-old female patient was admitted to the trauma center with a 4-cm-thick tree branch impaling her abdomen. The patient was transported by a medical helicopter and had stable vital signs at admission. The branch sticking out of the abdomen was quite long; thus, we carefully cut the branch with an electric saw to perform computed tomography (CT). CT revealed no signs of major blood vessel injury, but intestinal perforation was observed. During laparotomy, the tree branch was removed after confirming that there were no vascular injuries, and enterostomy was performed because of extensive intestinal injury. After treating other injuries, the patient was discharged without any complications except colostomy. Abdominal impalement injuries are treated using various approaches depending on the injury mechanism and injured region. However, the most important consideration is that the impaled object should not be removed during transportation and resuscitation. Instead, it should only be removed after checking for injuries to blood vessels during laparotomy in an environment where injury control is possible.; Summary

Original Articles

Epidemiology and outcomes of patients with penetrating trauma in Incheon Metropolitan City, Korea based on National Emergency Department Information System data: a retrsopective cohort study: Youngmin Kim, Byungchul Yu, Se-Beom Jeon, Seung Hwan Lee, Jayun Cho, Jihun Gwak, Youngeun Park, Kang Kook Choi, Min A Lee, Gil Jae Lee, Jungnam Lee; J Trauma Inj. 2023;36(3):224-230. Published online December 21, 2022; DOI: https://doi.org/10.20408/jti.2022.0055

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Abstract PDF: Purpose
Patients with penetrating injuries are at a high risk of mortality, and many of them require emergency surgery. Proper triage and transfer of the patient to the emergency department (ED), where immediate definitive treatment is available, is key to improving survival. This study aimed to evaluate the epidemiology and outcomes of patients with penetrating torso injuries in Incheon Metropolitan City.
Methods
Data from trauma patients between 2014 and 2018 (5 years) were extracted from the National Emergency Department Information System. In this study, patients with penetrating injuries to the torso (chest and abdomen) were selected, while those with superficial injuries were excluded.
Results
Of 66,285 patients with penetrating trauma, 752 with injuries to the torso were enrolled in this study. In the study population, 345 patients (45.9%) were admitted to the ward or intensive care unit (ICU), 20 (2.7%) were transferred to other hospitals, and 10 (1.3%) died in the ED. Among the admitted patients, 173 (50.1%) underwent nonoperative management and 172 (49.9%) underwent operative management. There were no deaths in the nonoperative management group, but 10 patients (5.8%) died after operative management. The transferred patients showed a significantly longer time from injury to ED arrival, percentage of ICU admissions, and mortality. There were also significant differences in the percentage of operative management, ICU admissions, ED stay time, and mortality between hospitals.
Conclusions
Proper triage guidelines need to be implemented so that patients with torso penetrating trauma in Incheon can be transferred directly to the regional trauma center for definitive treatment.; Summary

Impact of nonphysician, technology-guided alert level selection on rates of appropriate trauma triage in the United States: a before and after study: Megan E. Harrigan, Pamela A. Boremski, Bryan R. Collier, Allison N. Tegge, Jacob R. Gillen; J Trauma Inj. 2023;36(3):231-241. Published online September 13, 2023; DOI: https://doi.org/10.20408/jti.2023.0020

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Abstract PDF: Purpose
The rates of overtriage and undertriage are critical metrics in trauma care, influenced by the criteria for trauma team activation (TTA) and compliance with these criteria. An analysis of undertriaged patients at a level I trauma center revealed suboptimal compliance with existing criteria. This study was conducted to assess triage patterns after the implementation of compliance-focused process interventions.
Methods
Several workflow changes were made to transform a physician-driven, free-text alert system into a nonphysician, hospital dispatcher–guided system. The latter system employs dropdown menus to maximize compliance with existing TTA criteria. The preintervention period included patients who presented to the level I trauma center between May 12, 2020, and December 31, 2020. The postintervention period incorporated patients who presented from May 12, 2021, through December 31, 2021. We evaluated the rates of appropriate triage, overtriage, and undertriage using the Standardized Trauma Assessment Tool and patient characteristics from the trauma registry. All statistical analyses were conducted with an α level of 0.05.
Results
The patient characteristics were largely comparable between the preintervention and postintervention groups. The new system was associated with improved overall compliance with the existing TTA criteria (from 70.3% to 79.3%, P=0.023) and a decreased rate of undertriage (from 6.0% to 3.2%, P=0.002) at the expense of increasing overtriage (from 46.6% to 57.4%, P<0.001), ultimately decreasing the appropriate triage rate (from 78.4% to 74.6%, P=0.007).
Conclusions
This study assessed an easily implementable workflow change designed to improve compliance with TTA criteria. Improved compliance decreased undertriage rates to below the target threshold of 5%, albeit at the expense of increased overtriage. The observed decrease in appropriate triage despite compliance improvements suggests that the current TTA criteria at this institution are not adequately tailored to optimally balance the minimization of both undertriage and overtriage. This finding underscores the importance of improved compliance in evaluating the efficacy of TTA criteria.; Summary

Indications and findings of flexible bronchoscopy in trauma field in Korea: a case series: Dongsub Noh; J Trauma Inj. 2023;36(3):206-209. Published online September 13, 2023; DOI: https://doi.org/10.20408/jti.2022.0053

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Abstract PDF: Purpose
Since its implementation, flexible fiberoptic bronchoscopy (FBS) has played an important role in the diagnosis and treatment of tracheobronchial tree and pulmonary disease. Although FBS is often performed by endoscopists, it has also been performed by surgeons, albeit rarely. This study investigated FBS from the surgeon’s perspective.
Methods
This retrospective study included patients who underwent FBS performed by a single thoracic surgeon between March 2017 and December 2021. Accordingly, the epidemiology, purpose, results, and complications of FBS were analyzed.
Results
A total of 47 patients received FBS, whereas 13 patients underwent repeat FBS. Their mean age was 60.7 years. The main organs injured involved the chest (n=22), brain (n=9), abdominal organ (n=7), cervical spine (n=4), extremities (n=4), and face (n=1). The average Injury Severity Score was 22.5. Indications for FBS included atelectasis or haziness on chest x-ray (n=34), pneumonia (n=17), difficult ventilator management (n=7), percutaneous dilatory tracheostomy (n=3), blood aspiration (n=2), foreign body removal (n=2), and intubation due to a difficult airway (n=1). The findings of FBS were mucous plugs (n=36), blood and blood clots (n=16), percutaneous dilatory tracheostomy (n=2), foreign bodies (n=2), granulation tissue at the tracheostomy site (n=2), tracheostomy tube malposition (n=1), bronchus spasm (n=1), difficult airway intubation (n=1), and negative findings (n=5). None of the patients developed complications.
Conclusions
FBS is an important modality in the trauma field that allows for the possibility of diagnosis and therapy. With sufficient practice, surgeons may safely perform FBS at the bedside with relative ease.; Summary

Factors associated with the injury severity of falls from a similar height and features of the injury site in Korea: a retrospective study: Dae Hyun Kim, Jae-Hyug Woo, Yang Bin Jeon, Jin-Seong Cho, Jae Ho Jang, Jea Yeon Choi, Woo Sung Choi; J Trauma Inj. 2023;36(3):187-195. Published online November 16, 2022; DOI: https://doi.org/10.20408/jti.2022.0042

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Abstract PDF: Purpose
This study aimed to determine the risk factors associated with the severity of fall-related injuries among patients who suffered a fall from similar heights and analyze differences in injury sites according to intentionality and injury severity.
Methods
The Emergency Department-Based Injury In-depth Surveillance data collected between 2019 and 2020 were used in this retrospective study. Patients with fall-related injuries who fell from a height of ≥6 and <9 m were included. Patients were categorized into the severe and mild/moderate groups according to their excessive mortality ratio-adjusted Injury Severity Score (EMR-ISS) and the intention and non-intention groups. Injury-related and outcome-related factors were compared between the groups.
Results
In total, 33,046 patients sustained fall-related injuries. Among them, 543 were enrolled for analysis. A total of 256 and 287 patients were included in the severe and mild/moderate groups, respectively, and 93 and 450 patients were included in the intention and non-intention groups, respectively. The median age was 50 years (range, 39–60 years) and 45 years (range, 27–56 years) in the severe and mild/moderate groups, respectively (P<0.001). In multivariable analysis, higher height (odds ratio [OR] 1.638; 95% confidence interval [Cl], 1.279–2.098) and accompanying foot injury (OR, 0.466; 95% CI, 0.263–0.828) were independently associated with injury severity (EMR-ISS ≥25) and intentionality of fall (OR, 0.722; 95% CI, 0.418–1.248) was not associated with injury severity. The incidence of forearm injuries was four (4.3%) and 58 cases (12.9%, P=0.018) and that of foot injuries was 20 (21.5%) and 54 cases (12.0%, P=0.015) in the intention versus non-intention groups, respectively.
Conclusions
Among patients who fell from a similar height, age, and fall height were associated with severe fall-related injuries. Intentionality was not related to injury severity, and patients with foot injury were less likely to experience serious injuries. Injuries in the lower and upper extremities were more common in intentional and unintentional falls, respectively.; Summary

Case Report

Traumatic tension enterothorax in New Zealand: a case report: Monique Mahadik, Ashok Gunawardene, Aleisha Sutherland, Damien Ah Yen; J Trauma Inj. 2023;36(3):258-260. Published online February 27, 2023; DOI: https://doi.org/10.20408/jti.2022.0062

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Abstract PDF: Traumatic rupture of the right hemidiaphragm occurred following a high-velocity motor vehicle collision in the case presented herein. The resulting herniation of small bowel loops into the thorax resulted in hemodynamic and respiratory compromise due to pressure effects on the right heart and major vessels. The patient’s hemodynamic status improved with reduction of enterothorax, and the diaphragmatic defect was repaired. We discuss the available literature and learning points from this rare case.; Summary

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