Journal of Trauma and Injury

Original Articles

Resuscitative endovascular balloon occlusion of the aorta (REBOA) as a potential facilitator of definitive fascial closure in the open abdomen: a retrospective study in massive traumatic hemorrhage: Yoonjung Heo, Dong Hun Kim; J Trauma Inj. 2026;39(2):151-159. Published online June 30, 2026; DOI: https://doi.org/10.20408/jti.2025.0310

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Abstract PDF: Purpose
Resuscitative endovascular balloon occlusion of the aorta (REBOA) effectively reduces uncontrollable torso hemorrhage in trauma. An open abdomen (OA) with temporary abdominal closure commonly follows damage control surgery in such cases. Early definitive fascial closure (DFC) is crucial to prevent complications such as enteric fistula, peritoneal abscess, or chronic ventral hernia. This study aimed to evaluate the effect of REBOA on DFC after massive traumatic hemorrhage.
Methods
This retrospective study analyzed 839 patients requiring massive transfusion at a level I trauma center between 2015 and 2022. Subgroup analyses were conducted among patients who underwent OA and DFC. Primary outcomes were DFC achievement and timing (≤48 hours vs. >48 hours). Secondary outcomes included various clinical outcomes.
Results
Of 229 patients meeting inclusion criteria, 76 (33.2%) required OA management, of whom 33 (43.4%) achieved DFC. The OA+ group demonstrated more severe injury (median Injury Severity Score, 34.0 vs. 22.0; P<0.001) and higher REBOA utilization (47.4% vs. 15.0%, P<0.001). Multivariate analysis showed that bowel perforation (adjusted odds ratio [OR], 6.75; 95% confidence interval [CI], 1.56–29.23; P=0.011) and Sequential Organ Failure Assessment (SOFA) score (adjusted OR, 0.58; 95% CI, 0.43–0.79; P<0.001) were independently associated with DFC achievement; REBOA use was not. Among patients achieving DFC, univariate analysis identified OA indication (OR, 0.11), number of laparotomies (OR, 0.16), and crystalloid volume (OR, 1.00) as factors associated with early closure (≤48 hours), though none remained significant in multivariate analysis.
Conclusions
Zone I REBOA did not significantly influence the achievement or timing of DFC following OA in trauma patients with massive hemorrhage. The deteriorating condition in REBOA recipients and the limited sample size may have affected these findings. Nevertheless, several clinical indicators were associated with DFC, suggesting potential utility in trauma care decisions.; Summary

Blunt abdominal trauma: a retrospective study on clinical insights and treatment outcomes: Anurag Kumar, Rachith Sridhar, Harendra Kumar, Abdul Hakeem S., Abdul Vakil Khan, Majid Anwer; J Trauma Inj. 2025;38(3):221-231. Published online September 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0045

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Purpose
Blunt abdominal trauma is a significant cause of morbidity and mortality, predominantly affecting younger male patients. Therefore, a study examining the mechanisms of injury, injury patterns, and outcomes in these cases is essential. The aim of this study was to evaluate demographics, injury mechanisms, treatments provided, and outcomes in cases of blunt abdominal trauma at a level I trauma center in Eastern India.
Methods
A descriptive retrospective study was conducted at a level I trauma center using departmental audit data spanning 18 months (July 2022–December 2023). Data from 118 patients diagnosed with blunt abdominal trauma were analyzed.
Results
The study revealed a pronounced male predominance (6.35:1), with a mean age of 30.2 years. Road traffic accidents were the most frequent cause of injury (56.8%). Only six patients (5.1%) presented within the "golden hour," resulting in delayed interventions. Surgical intervention was necessary in 78 cases (66.1%), with hollow viscus perforation being the most common indication. The mean hospital stay was 10.6 days, and the overall mortality rate was 12.7%. The presence of shock upon admission significantly correlated with mortality (P<0.001).
Conclusions
Blunt abdominal trauma continues to represent a critical healthcare challenge, particularly affecting younger males. Improved healthcare accessibility, adherence to Advanced Trauma Life Support protocols, and timely interventions could improve survival rates.

Summary

Citations

Citations to this article as recorded by

Advances in abdominal wall imaging: The potential role of cinematic rendering
Zahra F. Rahmatullah, Elliot K. Fishman
Emergency Radiology.2026; 33(4): 923. CrossRef
Non-operative management of blunt abdominal trauma in a tertiary sub-Saharan surgical department: a retrospective cross-sectional analysis of 19 cases
Jacques Noel Tendeng, Armel Franck Tene Nde, Guillaume Tcheutchoua Soh, Diago Anta Dia, Latyr Diagne, Mohamed Lamine Diao, Philippe Manyacka Ma Nyemb, Ibrahima Konate
International Journal of Surgery: Global Health.2026;[Epub] CrossRef
An Unusual Case of Penetrating Abdominal Trauma With Important Clinical Lessons
Girish Bakhshi, Ranjitha R Maiyya, Chandrakant Sabale, Shweta Tungal, Swapnil Bhagat
Cureus.2026;[Epub] CrossRef
Diagnostic Challenges and Management of Blunt Traumatic Duodenal Diverticulum Perforation: A Systematic Review
Maciej Rybicki, Bartłomiej Białas, Karol Kamil Kłosiński, Zbigniew Włodzimierz Pasieka, Bartosz Marek Czyżewski, Piotr Tomasz Arkuszewski
Journal of Clinical Medicine.2026; 15(11): 4390. CrossRef
Pearls and pitfalls in the imaging of blunt bowel and mesenteric injury
Irfan Amir Kazi, Mohamed Elbanan, Ayman Gaballah, Amr Abdelaziz, Nanda Deepa Thimmappa, Bareen Waseem Kabir, Ayesha Nasrullah, Joe Jose, Verghese George, Vivek Yagnik, Rushabh Dev, M. Azfar Siddiqui
Abdominal Radiology.2026;[Epub] CrossRef
Clinical Learning-Curve Evidence and Experience-Related Temporal Trends of Resuscitative Endovascular Balloon Occlusion of the Aorta in Patients with Trauma: A Systematic Review
Bayarjargal Gavaadorj, Soon Ki Min, Youngmin Kim, Kang Kook Choi, Byungchul Yu, Gil Jae Lee, Dong Keon Yon, Wu Seong Kang
Journal of Clinical Medicine.2026; 15(18): 6959. CrossRef

Case Reports

Delayed open abdomen closure using a combination of acellular dermal matrix and skin graft in Korea: a case report: Yoonseob Kim, Tae Ah Kim, Hyung Min Hahn, Byung Hee Kang; J Trauma Inj. 2023;36(2):152-156. Published online November 4, 2022; DOI: https://doi.org/10.20408/jti.2022.0024

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1 Web of Science
1 Citations

Abstract PDF

Delayed closure of an open abdomen (OA) is a clinically challenging task despite its various modalities. It is substantially more difficult when the duration of OA treatment is prolonged due to a patient’s condition. We introduced the management of a patient who had a delayed OA treatment spanning approximately 3 months due to severe abdominal contamination. The 64-year-old male patient had an injured pelvis pressed by a road roller. After visiting a trauma center, the patient initially underwent damage control surgery and OA management; however, early primary abdominal closure failed due to severe peritonitis. After negative pressure wound therapy for several months, an acellular dermal matrix graft followed by a skin graft were successfully used as treatments. A combination of acellular dermal matrix graft, negative pressure wound therapy, and skin graft techniques is a considerable management sequence for patients subjected to delayed OA treatment.

Summary

Citations

Citations to this article as recorded by

The "open abdomen" method: history of development, evolution of approaches and modern tactics
O. Y. Usenko, O. S. Tyvonchuk, R. I. Vinogradov, Y. A. Vladymirenko
The Ukrainian Journal of Clinical Surgery.2025; 92(4): 56. CrossRef

Enteroatmospheric Fistula Associated with Open Abdomen: Jihun Gwak, Min A Lee, Dae Sung Ma, Kang Kook Choi; J Trauma Inj. 2016;29(4):195-200. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.195

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Abstract PDF

Enteroatmospheric fistula (EAF) is one of the most devastating complications in patients with an open abdomen and has associated morbidity and mortality rates. No gold standard therapy has been established for the treatment of EAF, and thus, treatment decision making is dependent on the experience of medical staff. Nevertheless, treatment involves the following; 1) sepsis must be managed, 2) sufficient nutritional support must be provided, and 3) effluent must be isolated from skin and open viscera. Here the authors present the case of a 29-year-old man who developed enteroatmospheric fistula after damage control laparotomy.

Summary

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From an Enteroatmospheric to an Enterocutaneous Fistula Using a Condom
Sofia Gaspar Reis, Patrícia Bernardo, Nuno Mendonça, Hélder Além, Zara Caetano
Cureus.2024;[Epub] CrossRef

Original Articles

Analysis of Abdominal Trauma Patients Using National Emergency Department Information System: In Gyu Song, Jin Suk Lee, Sung Won Jung, Jong Min Park, Han Deok Yoon, Jung Tak Rhee, Sun Worl Kim, Borami Lim, So Ra Kim, Il Young Jung; J Trauma Inj. 2016;29(4):116-123. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.116

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2 Citations

Abstract PDF

PURPOSE
To develop an inclusive and sustainable trauma system as the assessment of burden of injuries is very much important. The purpose of this study was to evaluate the estimates and characteristics of abdominal traumatic injuries.
METHODS
The data were extracted from the National Emergency Department Information System. Based on Korean Standard Classification for Disease 6th version, which is the Korean version of International Classification of Disease 10th revision, abdominal injuries were identified and abdominal surgeries were evaluated with electronic data interchange codes. Demographic factors, numbers of surgeries and clinical outcomes were also investigated.
RESULTS
From 2011 to 2014, about 24,696 patients with abdominal trauma were admitted to the hospitals annually in South Korea. The number of patients who were admitted to regional and local emergency medical centers was 8,622 (34.91%) and 15,564(63.02%), respectively. Based on National Emergency Department Information System, liver was identified as the most commonly injured abdominal solid organ (39.50%, 9,754/24,696, followed by spleen (17.57%, 4,338/24,696) and kidney (12.94%, 3,195/24,696).
CONCLUSION
This study shows that the demand for abdominal trauma care is considerable in South Korea and most of the patients with abdominal trauma were admitted to regional or local emergency centers. The results of this study can be used as good source of information for staffs to ensure proper delivery of abdominal trauma care in trauma centers nationally.

Summary

Citations

Citations to this article as recorded by

Endovascular embolization of persistent liver injuries not responding to conservative management: a narrative review
Simon Roh
Journal of Trauma and Injury.2023; 36(3): 165. CrossRef
Abdominal stab wound in A Pregnant woman resulting in Evisceration, Uterine Perforation and Fetal Chest Injury: A Case Report and Literature Review
Oumarou O, Landry TW, Joe NC, Wirwah FT, Ulrich BS, Jean-Paul EN
Journal of Surgery and Surgical Research.2019; : 010. CrossRef

Indications for an Immediate Laparotomy in Patients with Abdominal Stab Wounds: Hyeong Ju Kim, Seong Youn Hwang, Young Cheol Choi; J Korean Soc Traumatol. 2007;20(2):106-114.

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Abstract PDF: PURPOSE
There is little controversy that a classic indication such as hemodynamic instability or any sign of peritoneal irritation requires an immediate laparotomy in the management of abdominal stab wounds. However, omental herniation or bowel evisceration as an indication for an immediate laparotomy is controversial. The purpose of this study was to evaluate the significance of these factors as indications for an immediate laparotomy.
METHODS
The medical records of 98 consecutive abdominal stab wounds patients admitted to the Emergency Center of Masan Samsung Hospital from January 2000 to December 2006 were carefully examined retrospectively. Using multivariate logistic regression analysis, thirty-nine factors, including the classic indication and intraabdominal organ evisceration, were evaluated and were found to be associated with a need for a laparotomy. Also, the classic indication was compared with a new indication consisting of components of the classic indication and intra-abdominal organ evisceration by constructing a contingency table according to the need for a laparotomy.
RESULTS
Multivariate logistic regression analysis revealed any sign of peritoneal irritation, base deficit, and age to be significant factors associated with the need for a laparotomy (p<0.05). The sensitivity, specificity, and accuracy rates of the classic indication were 98.6%, 72.0%, and 91.8%, respectively, and those of the new indication were 93.2%, 84.0%, and 90.8%, respectively. The differences in those rates between the above two indications were not significant.
CONCLUSION
Intra-abdominal organ evisceration was not a significant factor for an immediate laparotomy. Moreover, the new indication including intra-abdominal organ evisceration was not superior to the classic indication. Therefore, in the management of abdominal stab wounds, the authors suggest that an immediate laparotomy should be performed on patients with hemodynamic instability or with any sign of peritoneal irritation.; Summary

Clinical Evaluation of Abdominal Stab Wound Patients in the ED: Jong Hak Park, Jung Youn Kim, Jun Hyun Shin, Young Hoon Yoon, Han Jin Cho, Sung Woo Moon, Sung Hyuk Choi, Sung Woo Lee, Yun Sik Hong; J Korean Soc Traumatol. 2010;23(1):21-28.

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Abstract PDF: PURPOSE
In Korea, most abdominal penetrating wounds are caused by stab wounds rather than gun-shot wounds. However, not many studies have been performed on stab injuries and their epidemiologic characteristics. Disagreements of opinions of obligatory surgical exploration and conservative treatment exist, and this subject is still being debated. Therefore, the authors studied the epidemiologic characteristics of abdominal stab wound patients visiting the emergency department and reviewed the proportion of patients that received non-therapeutic surgery and conservative treatment.
METHODS
This study included patients visiting the emergency department with abdominal stab wounds. A retrospective chart review was done on the abdominal stab wound patients. Sex, age, cause of injury, location of wound, initial vital signs, operation results, injured organs and CT & LWE results were reviewed.
RESULTS
The median age of the 121 patients was 40.9 years, of these patients, 88 were males, of which 52 (43.0%) were drunken. Of the patients that received non-therapeutic operations, only 3 patients (15.0%) were drunken, significantly lower than the therapeutic operation group. For the location of the wound, most patients were injured in the right and left upper quadrants, 27 patients each. The most common injured organ was the small bowel; 13 patients were injured in the small bowel. With abdominal CT scans and local wound explorations together, the results exhibited a sensitivity of 97%, a specificity of 44%, a positive predictive value of 56%, and a negative predictive value of 95%.
CONCLUSION
In our study, the sensitivity was 97% when CT & LWE were performed together; thus we can conclude that CT and LWE can be used together to select the treatment method. Although in our study, the surgical indications in abdominal stab wound patients is not sufficient, our results showed a higher rate of non-therapeutic surgery compared to previous studies. Therefore, more research is needed to prevent unnecessary laparotomies in hemodynamically-stable patients without symptoms.; Summary

Multiple Intraabdominal Solid Organ Injuries after Blunt Trauma: Hyung Do Park, Sun Hyu Kim, Jong Hwa Lee, Jung Seok Hong, Eun Seog Hong; J Korean Soc Traumatol. 2009;22(2):193-198.

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Abstract PDF: PURPOSE
This study evaluated the characteristics and the prognosis of multiple intraabdominal solid organ injuries, including those to the liver, spleen, and kidney, after blunt trauma.
METHODS
From January 2001 to March 2009, 39 patients with multiple intraabdominal solid organ injuries, which had been confirmed by contrast-enhanced computed tomography after blunt trauma, were included in this retrospective study. The injury severity score (ISS), abbreviated injury scale (AIS), revised trauma score (RTS), American Association for the Surgery of Trauma (AAST) injury grade of solid organs, initial hemodynamic status, blood gas analysis, blood transfusion, and the mortality were the main outcome measurements.
RESULTS
Injured groups were classified into liver/kidney (n=17), liver/spleen (n=4), spleen/kidney (n=13), and liver/kidney/spleen (n=5) groups. Patients were older in the liver/kidney group than in the liver/kidney/spleen group (43 vs 18 years, p=0.023). The initial systolic blood pressures tended to be lower in the liver/kidney group than in the other groups (84 vs 105, 112, and 114 mmHg, p=0.087). The amounts of 24-hour packed RBC transfusion were 32 units in the liver/kidney group and 4 units in the liver/kidney/spleen group, but the difference was not statistically significant. Differences were found in neither the RTS, ISS, and AIS for head, chest, abdominal, and pelvic injuries nor the AAST injury grade for solid organ, but injuries to the chest were more severe in the liver/spleen group than in the spleen/kidney group (AIS 4.0 vs 2.8, p=0.028). Conservative treatment was the most frequent applied treatment in all groups. There were 6 mortalities : 3 due to hypovolemia, 2 to sepsis, and 1 to brain injury. Mortalities occurred only in the liver/kidney group.
CONCLUSION
Patients who had intraabdominal solid organ injuries of the liver and the kidney simultaneously, tended to be transfused more at an early time after trauma, to have lower initial systolic blood pressures, and to have a higher mortality.; Summary

The Role of Single-contrast CT for Management in Hemodynamically Stable Anterior Abdominal Stab wound Patients: Janghwan Jo, Joongsuck Kim, Yeongcheol Kim, Ilyong Chung, Jongmin Park, Eunjung Ahn, Eunyoung Kim, Seihyeog Park, Seongyup Kim; J Trauma Inj. 2014;27(4):145-150.

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Abstract PDF: PURPOSE
To assess the accuracy and role of single-contrast computed tomography (CT) in the management of anterior abdominal stab wound (AASW).
METHODS
During 8-years period, single-contrast CT was performed in 21 hemodynamically stable AASW patients (age range, 22-64 years; median age, 45 years), including 19 men and 2 women. CT scans were evaluated by one trauma surgeon and one senior resident to determine the depth of injury(peritoneal violation or not), and abnormal findings of intraperitoneal cavity associated with stab injury. We retrospectively reviewed medical records regarding operative findings.
RESULTS
Nine patients underwent abdominal surgery and 12 patients nonoperative management. In the abdominal surgery group, abnormal CT findings included peritoneal violation in 14 patients and abnormal intraperitoneal cavity findings in 5 patients. There was no statistical significant difference regarding abnormal CT findings between abdominal surgery group and nonoperative management group. Among the nine abdominal surgery patients, therapeutic laparotomy was performed on 4 patients. The positive predictive value (PPV) and negative predictive value (NPV) of peritoneal violation to predictive therapeutic laparotomy were 28.6% and 100%, respectively. In addition, the PPV and NPV of abnormal intraperitoneal cavity CT findings to predict therapeutic laparotomy were 40.0% and 87.5%, respectively. There was no statistical significant difference regarding the abnormal CT findings between therapeutic laparotomy group and non therapeutic laparotomy group.
CONCLUSION
CT is a good adjunctive method to evaluate hemodynamicaly stable AASW patients. If peritoneal violation is not seen on CT scan, conservative treatment on local wound may be safely performed without additional abdominal surgery. However, further study is warranted to evaluate the exact role of CT in the diagnostic workup of AASW patients.; Summary

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