Journal of Trauma and Injury

Surgical management of supratentorial and infratentorial epidural hematoma in Korea: three case reports: Su Young Yoon, Junepill Seok, Yook Kim, Jin Suk Lee, Jin Young Lee, Mou Seop Lee, Hong Rye Kim; J Trauma Inj. 2023;36(4):399-403. Published online December 26, 2023; DOI: https://doi.org/10.20408/jti.2023.0073

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Abstract PDF: Supratentorial and infratentorial epidural hematoma (SIEDH) is a rare but life-threatening complication following traumatic brain injury. However, the literature on SIEDH is sparse, consisting only of a few small series. Prompt diagnosis and the application of appropriate surgical techniques are crucial for the rapid and safe management of SIEDH. Herein, we present three cases of SIEDH treated at our institution, employing a range of surgical approaches.; Summary

A case report of “minor” trauma leading to a major disability: whiplash-associated dysphagia, dysphonia, and dysgeusia: Ami Schattner, Yair Glick; J Trauma Inj. 2022;35(2):115-117. Published online May 19, 2022; DOI: https://doi.org/10.20408/jti.2021.0043

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Abstract PDF: “Whiplash”-type injuries are commonly encountered and often cause neck pain, neck stiffness, and headaches. However, these injuries can have rare and poorly recognized complications, such as the development of a prevertebral hematoma leading to acute respiratory failure in the emergency department, followed by severe, life-threatening dysphagia and recurrent aspirations. In the patient described herein, a whiplash injury was accompanied by vocal cord paralysis and dysphonia (vagus nerve), dysgeusia (glossopharyngeal nerve, vagus nerve), and upper esophageal spasm (cricopharyngeal muscle, vagus nerve). It is unlikely that this was a complication of cervical fusion surgery. Instead, a combined stretch-induced lower cranial nerve injury, possibly on the exit of these nerves through the jugular foramen, seems to be a likely, but underappreciated mechanism occurring in rare instances of whiplash injuries.; Summary

Chronic epidural hematoma evacuated through surgical treatment: a case report: Eui Gyu Sin; J Trauma Inj. 2022;35(1):43-45. Published online March 21, 2022; DOI: https://doi.org/10.20408/jti.2021.0036

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Epidural hematoma (EDH) can sometimes be life-threatening, although small-volume EDHs can resolve spontaneously like other intracranial hematomas. However, in rare cases, EDH can transform into a chronic form instead of disappearing. In contrast to subdural hematoma, there is no agreed-upon definition or treatment of chronic EDH. A 41-year-old male patient with acute EDH in the bilateral paravertical area due to partial rupture of the sagittal sinus was operated first, and then remnant contralateral hematoma was treated conservatively. One month after surgery, he showed hemiparesis, and brain imaging revealed chronic EDH at the location of the remnant acute hematoma. We performed surgery again to treat chronic EDH through a large craniotomy. Although many cases of EDH are self-limited, clinicians must keep in mind that some cases of EDH, especially those of venous origin and arising in young people, can become chronic and require surgical treatment.

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Chronic epidural hematoma: a systematic review and meta-analysis
Nicaise Kpègnon Agada, Nourou Dine Adeniran Bankole, Mèhomè Wilfried Dossou, Omar Boladji Adébayo Badirou, Emeka Alfred Clement, Fresnel Lutèce Ontsi Obame, Laté Dzidoula Lawson, Romeo Bujiriri Murhega, Arsène Daniel Nyalundja, Nukunté David Lionel Togben
Egyptian Journal of Neurosurgery.2023;[Epub] CrossRef

Very large haematoma following the nonoperative management of a blunt splenic injury in a patient with preexisting liver cirrhosis: a case report: Euisung Jeong, Younggoun Jo, Yunchul Park, Jungchul Kim, Hyunseok Jang, Naa Lee; J Trauma Inj. 2022;35(1):66-70. Published online December 24, 2021; DOI: https://doi.org/10.20408/jti.2021.0077

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Abstract PDF: The spleen is the most commonly injured organ after blunt abdominal trauma. Nonoperative management (NOM) is the standard treatment for blunt splenic injuries in haemodynamically stable patients without peritonitis. Complications of NOM include rebleeding, new pseudoaneurysm formation, splenic abscess, and symptomatic splenic infarction. These complications hinder the NOM of patients with blunt splenic injuries. We report a case in which a large haemorrhagic fluid collection that occurred after angio-embolisation was resolved by percutaneous drainage in a patient with liver cirrhosis who experienced a blunt spleen injury.; Summary

Successful endovascular embolization for traumatic subcutaneous abdominal wall hematoma via the superficial inferior epigastric artery: a case report: Sung Nam Moon, Sang Hyun Seo, Hyun Seok Jung; J Trauma Inj. 2022;35(2):128-130. Published online June 10, 2021; DOI: https://doi.org/10.20408/jti.2020.0079

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Abstract PDF: Abdominal wall hematoma (AWH) after blunt trauma is common, and most cases can be treated conservatively. More invasive treatment is required in patients with traumatic AWH if active bleeding is identified or there is no response to medical treatment. Herein, we report a case of endovascular embolization for traumatic subcutaneous AWH. Almost endovascular treatment for AHW is done through the deep inferior epigastric artery. However, in this case, the superficial inferior epigastric artery was the bleeding focus and embolization target. After understanding the vascular system of the abdominal wall, an endovascular approach and embolization is a safe and effective treatment option for AWH.; Summary

Iatrogenic Duodenal Obstruction due to Acupuncture Therapy Trauma: Jae Hun Chung, Si-Hak Lee; J Trauma Inj. 2021;34(1):70-74. Published online November 24, 2020; DOI: https://doi.org/10.20408/jti.2020.0011

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There are many possible causes of duodenal obstruction, such as congenital anomalies and various acquired conditions associated with space-occupying lesions. However, hemorrhage or retroperitoneal hematoma is a rare cause of duodenal obstruction. Here, we report the case of a 55-year-old man who developed duodenal obstruction due to a large retroperitoneal hematoma after acupuncture therapy. The patient experienced abdominal discomfort along with vomiting and nausea. Considering the size of the hematoma, emergency surgery could have been performed, but conservative treatment was continued because the patient’s vital signs were stable. With spontaneous resolution of the hematoma, the symptoms of duodenal obstruction improved. The patient was eventually discharged without any complications associated with the hematoma. Our findings suggest that even when a hematoma is large, a conservative approach can be maintained until improvement of the symptoms of duodenal obstruction if the vital signs of the patient remain stable.

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The reporting quality of acupuncture-related traumatic adverse events: a systematic review of case studies in Korea
Sung-A Kim, Ji-Su Lee, Tae-Hun Kim, Seunghoon Lee, Jae-Dong Lee, Jung Won Kang
BMC Complementary Medicine and Therapies.2024;[Epub] CrossRef

Traumatic Posterior Fossa Subdural Hematoma in a Neonate: A Case Report: Ki Seong Eom; J Trauma Inj. 2020;33(4):256-259. Published online November 10, 2020; DOI: https://doi.org/10.20408/jti.2020.009

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Abstract PDF: Although traumatic posterior fossa subdural hematoma (TPFSH) in neonates immediately after birth is extremely rare, it can pose a serious clinical problem in the neonatal period. Here, the author presents the case of a 3-day-old male infant who underwent emergency surgical treatment of TPFSH with a favorable outcome. Debate continues about surgical versus conservative treatment of TPFSH in neonates. The clinical symptoms, extent of hemorrhage, early diagnosis, and prompt and appropriate surgery are the most important factors in the treatment of TPFSH in neonates. Therefore, neurosurgeons should establish treatment strategies based on the newborn’s clinical condition, the size and location of the TPFSH, and the potential of the hematoma to cause long-term complications.; Summary

Comparison of Outcomes and Recurrence in Chronic Subdural Hematoma Patients Treated by Burr-Hole Drainage with or without Irrigation: Jongwook Choi, Kum Whang, Sungmin Cho, Jongyeon Kim; J Trauma Inj. 2020;33(2):81-87. Published online June 5, 2020; DOI: https://doi.org/10.20408/jti.2020.003

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Purpose

Chronic subdural hematoma (CSDH) is a common disease in elderly patients and is usually treated by burr-hole drainage. However, the optimal surgical technique for treating CSDH has not been determined. In this study, we analyzed outcomes and recurrence rates after burr-hole drainage with or without irrigation in patients with CSDH.

Methods

Eighty-two CSDH patients treated with burr-hole drainage at Wonju Severance Christian Hospital from March 2015 to June 2016 were enrolled in this study. The subjects were divided into three groups based on the surgical technique performed as follows: single burr-hole drainage without irrigation (group A, n=47), single burr-hole drainage with irrigation (group B, n=14), or double burr-hole drainage with irrigation (group C, n=21). These three groups were compared with respect to clinical and radiological factors and the recurrence rate, and independent factors predicting recurrence were sought.

Results

After burr-hole drainage, CSDH recurred in 15 (18.3%) of the 82 patients, and six patients (7.3%) required reoperation. More specifically, recurrence was observed in 12 patients (25.5%) in group A, one (7.1%) in group B, and two (9.5%) in group C. The number of burr-holes did not significantly affect recurrence (odds ratio [OR]=0.38; 95% confidence interval [CI]: 0.60–2.38), but irrigation had a significant effect (OR=0.20; 95% CI: 0.04–0.97).

Conclusions

This study shows that irrigation during burr-hole surgery in CSDH patients significantly reduced the risk of recurrence, regardless of the number of burrholes used. We therefore recommend the use of active irrigation during burr-hole drainage surgery in CSDH patients.

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Factors Associated with Recurrence in Chronic Subdural Hematoma following Surgery
Kritsada Buakate, Thara Tunthanathip
Journal of Health and Allied Sciences NU.2024; 14(01): 085. CrossRef
Factors Associated With Short-Term Outcomes of Burr-Hole Craniostomy Associated With Brain Re-Expansion and Subdural Hematoma Shrinkage for Chronic Subdural Hematoma
Gyubin Lee, Yeongyu Jang, Kum Whang, Sungmin Cho, Jongyeon Kim, Byeongoh Kim, Jongwook Choi
Korean Journal of Neurotrauma.2023; 19(3): 324. CrossRef

Delayed manifestation of Isolated Intramural Hematoma of the duodenum resulting from Blunt abdominal Trauma: Tae Sun Ha, Jun Chul Chung; J Trauma Inj. 2020;33(1):53-58. Published online March 30, 2020; DOI: https://doi.org/10.20408/jti.2019.042

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Duodenal injury following blunt abdominal trauma is a relatively unusual complication, and it may sometimes be difficult to distinguish a duodenal hematoma from duodenal perforation. According to recent reports, intramural hematomas typically resolve spontaneously with conservative treatment. Surgery, however, is occasionally necessary in some cases if the diagnosis is delayed, conservative therapy fails, or a high degree of suspicion of duodenal injury persists. We experienced a case of delayed manifestation of a duodenal intramural hematoma that was surgically treated.

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Intramural duodenal hematoma: diagnosis and management of a rare entity
Álvaro Pérez-Rubio, Juan Carlos Sebastián-Tomás, Sergio Navarro-Martínez, Marta Córcoles Córcoles, Carlos Domingo del Pozo
Cirugía Española (English Edition).2023; 101(7): 515. CrossRef
Hematoma intramural duodenal: diagnóstico y manejo de una entidad infrecuente
Álvaro Pérez-Rubio, Juan Carlos Sebastián-Tomás, Sergio Navarro-Martínez, Marta Córcoles Córcoles, Carlos Domingo del Pozo
Cirugía Española.2023; 101(7): 515. CrossRef

Traumatic Extrapleural Hematoma Mimicking Hemothorax: Yong Seon Choi, Soon Jin Kim, Sang Woo Ryu, Seung Ku Kang; J Trauma Inj. 2017;30(4):202-205. Published online December 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.4.202

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After blunt chest injuries, extrapleural hematoma may result in a collection of blood between the parietal pleura and the endothoracic fascia. Extrapleural hematoma is frequently misdiagnosed as hemothorax. Extrapleural fat sign, the inward displacement of strip of extrapleural fat on computed tomography, is typical radiological findings of extrapleural hematoma. We encountered a case of extrapleural hematoma with a presentation similar to hemothorax after blunt chest injury.

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Hemothorax or not: Use of extrapleural fat sign
Rajat Dahiya, Thaker Nirav, Jaggi Sunila, Talwar Inder
West African Journal of Radiology.2021; 28(1): 18. CrossRef

A Successful Evacuation of Vertex Epidural Hematoma; A Case Report: Jang Hun Kim, Haewon Roh, Jong Hyun Kim, Taek Hyun Kwon; J Trauma Inj. 2017;30(3):98-102. Published online October 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.3.98

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Abstract PDF: Vertex epidural hematoma (VEH) is an uncommon presentation of all epidural hematomas and presents with a wide range of symptom and signs. Diagnosis as well as treatment of VEH is also difficult because of its location adjacent to superior sagittal sinus (SSS). A 43-year-old male visited our hospital after fall down and was diagnosed with VEH. While evaluating its location and patency of SSS, he was deteriorated and urgently underwent evacuation of VEH. Bilateral craniotomies on each side, leaving a central bony island to avoid bleeding of midline structure and provide an anchor for dural tack-ups. After the operation, VEH was totally removed and the patient has restored.; Summary

Hydronephrosis during Conservative Treatment for a Renal Injury Patient: Maru Kim, Joongsuck Kim, Sung Jeep Kim, Hang Joo Cho; J Trauma Inj. 2017;30(2):47-50. Published online June 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.2.47

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Abstract PDF: A 21-year-old male visited our emergency room. He could not remember the mechanism of injury. He was found beside a motorcycle. Initial vital sign was stable. Observation and conservative treatment were planned at the intensive care unit (ICU). On the third day at ICU, he complained sudden flank pain. It was colicky and hard to control. Without the pain, he had no specific symptom, sign, or laboratory findings. On computed tomography, renal pelvis was filled with hematoma which induced hydronephrosis. Double-J catheter and percutaneous nephrostomy was implemented by an intervention radiologist. Hematome in the renal pelvis was aspirated during the procedure. Symptom of the patient was subsided after the procedure. He was discharged without specific complications.; Summary

External Iliac Artery Injury Caused by Abdominal Stab Wound: A Case Report: Sang Bong Lee, Jae Hun Kim, Chan Ik Park, Kwang Hee Yeo; J Trauma Inj. 2015;28(3):215-218. Published online September 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.3.215

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Abstract PDF: Traumatic iliac vessel injuries constitute approximately 25% of all abdominal vascular injuries. Hospital mortality has been reported at 25~60% and is a result of uncontrolled hemorrhage and hypovolemic shock caused by extensive blood loss. We report the case of a 25-year-old female patient who experienced an external iliac artery injury caused by abdominal minimal stab wound. Traumatic iliac vessel injuries are life-threatening complication of abdominal or pelvic injuries and prompt diagnosis and accurate treatment are important.; Summary

Bilateral Spontaneous Resolution of Chronic Subdural Hematoma: A Case Report: Gyeongung Seon, Ji Min Park, Ki Seong Eom; J Trauma Inj. 2015;28(1):43-46. Published online March 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.1.43

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Abstract PDF: Although spontaneous resolution of chronic subdural hematoma (C-SDH) in the elderly has rarely been reported, spontaneous resolution of bilateral C-SDH is very rare. Here, we report the case of a 73-year-old female patient with no significant head trauma history who had a bilateral C-SDH spontaneously resolve despite receiving only conservative treatment. However, because of a lack of detailed knowledge about the mechanisms of resolution, treatment is often limited to surgical interventions that are generally successful, but invasive and prone to recurrence. We review the literature and discuss the possible relation of C-SDH's spontaneous resolution with its clinical and radiological characteristics.; Summary

Successful Angiographic Embolization of Superficial Circumflex Iliac Artery Rupture Caused by Blunt Abdominal Trauma: A Case Report: 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; J Trauma Inj. 2015;28(1):39-42. Published online March 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.1.39

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Abstract PDF: 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.; Summary

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