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Original Article
- Treatment strategy for acute blunt traumatic abdominal wall injury: a single-center retrospective study in Korea
- Gun Woo Kim, Chang-Yeon Jung, Sung Hoon Cho, Suyeong Hwang, Kyoung Hoon Lim
- J Trauma Inj. 2025;38(4):373-381. Published online December 31, 2025
- DOI: https://doi.org/10.20408/jti.2025.0234
- 4,496 View
- 35 Download
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Abstract
PDF - Purpose
Traumatic abdominal wall hernia, a rare condition resulting from blunt trauma, is characterized by disruption of the abdominal wall musculature and fascia without skin penetration. Given its rarity, standardized treatment guidelines are lacking, and the necessity for immediate surgery remains debated. This study examines high-energy posterolateral abdominal wall injuries (AWI), which pose significant management challenges due to their anatomical complexity and high recurrence risk.
Methods
We retrospectively reviewed records of 44 adults with grade III–VI AWI treated between 2013 and 2023 at a level I trauma center. Patients were categorized into emergency repair or delayed management groups based on the initial treatment strategy, with injuries anatomically classified as anterior, lateral, or posterolateral. Nonoperative management (NOM) was limited to patients without herniation on index imaging and entailed close observation with regular follow-up imaging.
Results
AWI was identified in 44 of 83,532 patients (0.05%) with blunt trauma. Anatomically, 4 cases (9.1%) were anterior, 17 (38.6%) were lateral, and 23 (52.3%) were posterolateral. Three patients (6.8%) were classified as grade III injury, 16 (36.4%) as grade IV, 24 (54.6%) as grade V, and 1 (2.3%) as grade VI. Emergency repair was performed in 26 patients (59.1%), whereas 18 (40.9%) initially received delayed management. In the latter group, 8 of 18 patients (44.4%) were judged to require delayed repair, of whom six proceeded to surgery. Among 10 NOM patients with indeterminate muscle-layer integrity on initial imaging due to hematoma or tissue injury, follow-up revealed delayed hernia development in three, while seven had resolved hematoma, confirming wall integrity.
Conclusions
In hemodynamically stable patients with traumatic posterolateral AWI without herniation, NOM with close monitoring and delayed repair for subsequent hernia appears safe and effective as an alternative to immediate surgery. Management should be tailored to injury location and patient condition. These findings inform the management timing and approach for this rare, challenging injury pattern. -
SummaryCase Report
- Reperfusion injury or cytokine storm? Utilizing plasmapheresis in severe trauma-induced multiorgan failure: a case report
- Gun Woo Kim, Suyeong Hwang, Kyoung Hoon Lim, Sung Hoon Cho
- J Trauma Inj. 2024;37(4):295-299. Published online December 4, 2024
- DOI: https://doi.org/10.20408/jti.2024.0051
- 5,161 View
- 77 Download
- 1 Web of Science
- 3 Citations
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Abstract
PDF
- Reperfusion injury can cause tissue damage due to ischemia, with severe cases potentially resulting in multiorgan failure. Cytokine storm, a life-threatening systemic inflammatory state characterized by elevated levels of circulating cytokines and hyperactive immune cells, can also lead to tissue damage and multiorgan failure. Reperfusion injury and cytokine storm sometimes exhibit similar clinical features, necessitating specific treatment in severe cases. A 31-year-old man sustained a stab wound to his left knee. Computed tomography angiography and surgical exploration revealed a transection of the left popliteal artery and vein. Both vessels were revascularized via end-to-end anastomosis approximately 3 hours after the injury. On postoperative day 2, marked increases were observed in levels of aspartate aminotransferase (8,600 U/L), alanine transaminase (6,690 U/L), creatine phosphokinase (26,817 U/L), and lactate dehydrogenase (7,398 U/L) levels. Elevated levels of interleukin 6 (178 pg/mL) and ferritin (41,079 ng/mL) were also noted. Given the possibility of either reperfusion injury or cytokine storm, plasmapheresis was initiated. Following two rounds of plasmapheresis, the patient’s condition rapidly improved, and he was discharged without complications. Reperfusion injury can arise when a target blood vessel is revascularized, particularly during severe stages of ischemia. Cytokine storm represents a life-threatening systemic inflammatory state characterized by high levels of circulating cytokines and overactive immune cells. Both reperfusion injury and cytokine storm can cause systemic inflammation and multiorgan failure. These two conditions may exhibit similar clinical features, necessitating supportive care primarily to prevent organ dysfunction. However, plasmapheresis may represent an effective treatment option in cases of severe progression.
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Summary
Citations
Citations to this article as recorded by
- Transcatheter Intra‐Arterial Delivery of a Platelet‐Derived Extracellular Vesicle‐Enriched Preparation for Attenuating Skeletal Muscle Ischaemia‐Reperfusion Injury in a Rodent Forelimb Model
Omar A. Selim, Aida Sarcon, Atta Behfar, Chunfeng Zhao, Steven L. Moran
Journal of Extracellular Vesicles.2026;[Epub] CrossRef - The significance of inflammasome activation during each phase of wound healing
Carol M. Artlett
Exploration of Medicine.2025;[Epub] CrossRef - Systemic Complications Leading to MODS in a Trauma Patient: A Case-Based Pathophysiologic Analysis
Yalım Benibol, Ahmet Hakan Erol
Kocaeli Üniversitesi Sağlık Bilimleri Dergisi.2025; 11(3): 177. CrossRef
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