Journal of Trauma and Injury

Case Reports

Penetrating liver injury caused by a metal fragment from a blast accident in a factory: a case report: Chan Hee Park, Jeong Woo Lee; J Trauma Inj. 2022;35(Suppl 1):S8-S14. Published online June 3, 2022; DOI: https://doi.org/10.20408/jti.2021.0085

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Abstract PDF Supplementary Material: Penetrating abdominal injuries are rare in countries that do not allow legal possession of firearms by the public. We report a case of a 27-year-old male patient with a penetrating liver injury caused by metal fragments released in a blast accident. On the day of the accident, there was a metal explosion, and multiple fragments of the metal lodged in the patient’s abdomen. The metal fragments were widely distributed over the abdomen and limited to the subcutaneous layer. A computed tomography scan showed that one metal fragment had penetrated near the right upper quadrant. First, we tried exploratory laparoscopy to accurately locate and remove the presumed metal fragment under the liver, on the side of the gallbladder, and near the duodenum. However, we could not find the metal fragment and converted the procedure to open laparotomy. The metal fragment was found to be completely lodged in segment 4, the quadrate lobe to the left of the gallbladder. To remove the fragment, a 2-cm incision was made on the liver surface where the metal fragment was found. The patient’s general postoperative condition was satisfactory, with no findings of bile leakage or bleeding. In conclusion, clinicians who do not have experience with these injuries can still provide adequate treatment by selecting a treatment method based on the patient’s condition as well as the velocity of trauma. The laparoscopic approach, as a less invasive procedure, may be worthwhile for treating penetrating trauma. Additionally, laparoscopic exploratory laparotomy may be considered in selected cases.; Summary

Non-Operative Management of Traumatic Gallbladder Bleeding with Cystic Artery Injury: A Case Report: Tae Hoon Kim; J Trauma Inj. 2021;34(3):208-211. Published online August 19, 2021; DOI: https://doi.org/10.20408/jti.2021.0003

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Abstract PDF: Gallbladder injuries are rare in cases of blunt abdominal trauma and are usually associated with damage to other internal organs. If the physician does not suspect gallbladder injury and check imaging studies carefully, it may be difficult to distinguish a gallbladder injury from gallbladder stone, hematoma, or bleeding. Therefore, in order not to miss the diagnosis, the clinical findings and correlation should be confirmed. In the present case, a 60-year-old male presented to a local trauma center complaining of pain in the upper right quadrant and chest wall following a motor vehicle collision. Abdominal computed tomography (CT) showed a hepatic laceration and hematoma in the parenchyma in segments 4, 5, and 6 and active bleeding in the lumen of the gallbladder. Traumatic gallbladder injuries generally require surgery, but in this case, non-operative management was possible with cautious follow-up consisting of abdominal CT and angiography with repeated physical examinations and hemodynamic monitoring in the intensive care unit.; Summary

Hepatic Hemangioma Rupture Caused by Blunt Trauma: Gil Hwan Kim, Jae Hun Kim, Sang Bong Lee; J Trauma Inj. 2017;30(4):235-237. Published online December 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.4.235

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Abstract PDF

Hepatic hemangioma is the most frequently occurring benign tumor of the liver. Hepatic hemangioma rupture is a rare phenomenon, which can lead to life-threatening conditions. Here, we report a case of hepatic hemangioma rupture caused by blunt trauma. Explorative laparotomy was performed due to unstable vital signs and abdominal massive hemoperitoneum revealed on computed tomography. We detected arterial bleeding from a hepatic hemangioma and performed primary suture of the liver and postoperative angiographic embolization.

Summary

Citations

Citations to this article as recorded by

Post‐traumatic rupture of hepatic haemangioma
Tessa Gaynor, Vanshika Sinh, Jonathan Reddipogu
ANZ Journal of Surgery.2023; 93(11): 2754. CrossRef

Original Articles

The Impact of Trauma Center Establishment on Laparotomy Patterns and Outcomes in Severe Hemoperitoneum Patients: Min A Lee, Jungnam Lee, Min Chung, Giljae Lee, Jaejeong Park, Kangkook Choi, Byung Chul Yoo; J Trauma Inj. 2017;30(1):6-11. Published online March 31, 2017; DOI: https://doi.org/10.20408/jti.2017.30.1.6

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Abstract PDF: PURPOSE
The establishment of the trauma system has changed the quality of trauma care in many countries. As one of the first designated level I trauma centers in Korea, we hypothesized that there were changes in laparotomy patterns and subsequent survival rates after the center was established.
METHODS
This was a 5-year retrospective study of all severe hemoperitoneum patients who were transfused with more than 10 units of packed red blood cells (RBCs) within 24 h of hospitalization. Variables related to trauma were collected throughout the study period, and the patients admitted before (period 1) and after (period 2) the establishment of a trauma center were compared.
RESULTS
Forty-five patients were managed from January 2009 to March 2015. The baseline patient characteristics of the two groups, including age, Injury Severity Score, blood pressure, and hemoglobin levels, were similar. The time to the operating room (OR) was 144.3±51.5 min (period 1) and 79.9±44.1 min (period 2) (p<0.0001). Damage control surgery (DCS) was performed in 17% of patients during period 1 and in 73% during period 2. The number of actual survivors (n=10) was higher than expected (n=8) in period 2.
CONCLUSION
This is the first study analyzing the impact of a trauma center on the management of specific injuries, such as severe hemoperitoneum, in patients in Korea. During the study, the time to OR was shortened and DCS was used to a greater extent as a surgical procedure.; Summary

Effect on Trauma Patients of Having Even One General Trauma Surgeon on Duty: Jang Whan Jo, Jun Min Cho, Nam Ryeol Kim; J Trauma Inj. 2016;29(1):8-13. Published online March 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.1.8

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Abstract PDF

PURPOSE
Specialized general trauma surgeons play an important role in the care of trauma patients. Hemoperitoneum is a severe, but representative, condition following a life-threatened trauma. The objective of this study was to compare the outcomes for polytrauma patients with hemoperitoneum between the periods during which a trauma surgeon was available and that unavailable.
METHODS
Thirty-one trauma patients with hemoperitoneum who were treated at Korea University Guro Hospital over a period of 4 years were included in this study, and their case records were analyzed retrospectively. The patients were divided into two groups, the 2011 and 2012 group and the 2013 and 2014 group corresponding, respectively, to the periods that a trauma surgeon was not and was working. Vital signs on admission, scores on the injury severity scale and, Glasgow coma scale, elapsed time to diagnostic, and therapeutic, and/or operative interventions were studied. The effects on intensive care unit and hospital lengths of stay, as well as mortality, were also studied.
RESULTS
The study population consisted of 16 and 15 patients in group 1 and 2, respectively. The patients in both groups had six unstable hemodynamic on admission. The time to the main procedure (intervention, operation etc.) was longer during the periods when a trauma surgeon was not working than it was during the period when working. This difference did not reached statistical significance. The mortality rates for the two groups were not statistically different either (18.75% vs 26.67%; p=0.928).
CONCLUSION
Having at least one specialized general trauma surgeon on duty may reduce the time to intervention and surgery for severe trauma patients with hemoperitoneum, but appears to have no effect on the mortality rates. In conclusion, having only one trauma surgeon on duty does not improve the quality of care for trauma patients.

Summary

Citations

Citations to this article as recorded by

Significance of orthopedic trauma specialists in trauma centers in Korea
Yong-Cheol Yoon, Chang-Wug Oh, Jong-Keon Oh
Archives of Orthopaedic and Trauma Surgery.2019; 139(10): 1379. CrossRef

Usefulness of FAST for Evaluation of Blunt Abdominal Trauma Patients: Yong Sik Chu, Ok Jun Kim, Sung Uk Choi, Jung Han Lee; J Korean Soc Traumatol. 2006;19(2):135-142.

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Abstract PDF: PURPOSE
We planned to determine the diagnostic capability of focused assessment with sonography for trauma (FAST) in cases of blunt abdominal injury (BAI).
METHODS
A retrospective analysis of FAST sheets was performed from April 2002 to December 2004. During the study period, 135 BAI patients were evaluated with FAST at the Emergency Department of Bundang CHA Hospital. Of this group, twenty-eight patients were excluded, leaving 107 patients for analysis. Abdomen CT (computerized tomography) or exploratory laparotomy confirmed the presence of hemoperitoneum. At the secondary survey, patients underwent a three-view FAST examination (LogicQ; General Electric, Waukesha, USA) by an emergency physician, followed within 2 hours by an abdomen CT or exploratory laparotomy. The FAST examination was considered positive if it demonstrated evidence of free intra-abdominal fluid.
RESULTS
There were 45 true-positive FAST examination, 57 true-negatives, 1 false-positive, and 4 false negatives (sensitivity 91.8%, specificity 98.3%, positive predictive value 97.8%, negative predictive value 93.4%). The area under the ROC curve was 0.951 for the FAST examination.
CONCLUSION
FAST is a highly reliable method for screening patients suspected of having BAI for the presence or absence of hemoperitoneum.; Summary

Case Report

Delayed Splenic Rupture Following Minor Trauma in a Patient with Underlying Liver Cirrhosis: Kyung Woon Jeung, Byung Kook Lee, Hyun Ho Ryu; J Korean Soc Traumatol. 2011;24(1):52-55.

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Abstract PDF: The spleen is the most frequently injured organ following blunt abdominal trauma. However, delayed splenic rupture is rare. As the technical improvement of computed tomography has proceeded, the diagnosis of splenic injury has become easier than before. However, the diagnosis of delayed splenic rupture could be challenging if the trauma is minor and remote. We present a case of delayed splenic rupture in a patient with underlying liver cirrhosis. A 42-year-old male visited our emergency department with pain in the lower left chest following minor blunt trauma. Initial physical exam and abdominal sonography revealed only liver cirrhosis without traumatic injury. On the sixth day after trauma, he complained of abdominal pain and diarrhea after eating snacks. The patient was misdiagnosed as having acute gastroenteritis until he presented with symptoms of shock. Abdominal sonography and computed tomography revealed the splenic rupture. The patient underwent a splenectomy and then underwent a second operation due to postoperative bleeding 20 hours after the first operation. The patient was discharged uneventfully 30 days after trauma. In the present case, the thrombocytopenia and splenomegaly due to liver cirrhosis are suspected of being risk factors for the development of delayed splenic rupture. The physician should keep in mind the possibility of delayed splenic rupture following blunt abdominal or chest trauma.; Summary

Original Articles

Prognostic Factors in Patients Who Performed Angiographic Embolization for the Bleeding from Injury of the Intraabdominal Organ and Pelvic Area: Jin Ho Lee, Ji Young Jang, Hong jin Shim, Jae Gil Lee; J Trauma Inj. 2012;25(4):166-171.

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Abstract PDF: PURPOSE
In patients with traumatic hemoperitoneum or pelvic bone fracture who underwent angiography and embolization, we want to find the prognostic factors related with mortality.
METHODS
Patients(333 patients) who visited our hospital with traumatic injury from March 2008 to April 2012 were included in this study. Only 37 patients with traumatic hemoperitoneum or pelvic bone fracture underwent angiography and embolization. A retrospective review was conducted, and Glasgow coma scale (GCS), Revised trauma score (RTS), Injury severity score (ISS), initial laboratory finding and time interval, the amount of transfusion from the arrival at the ER to the start of embolization, and the vital signs before and after procedure were checked. Stastical analysis was conducted using the Chi square and Mann-Whitney U test.
RESULTS
In univariate analysis, the amount of transfusion, the base deficit before procedure, the systolic blood pressure before and after the procedure, the GCS, the RTS and the ISS were significantly associated with prognosis. In the multivariate analysis, the ISS and the base deficit had significant association with prognosis. Of the 37 patients who underwent angiography and embolization, 31 patients needed not additional procedure (Group A) while the other 6 patients needed an additional procedure (Group B). After procedure, a statistically significant higher blood pressure was observed in Group A than in Group B. As to the difference in blood pressure before and after the procedure, a statistically significant decrease in systolic blood pressure was observed in Group B, but an increase was observed in Group A.
CONCLUSION
In traumatic hemoperitoneum or pelvic bone fracture patients who underwent angiography and embolization, GCS, ISS, RTS, transfusion amount before the procedure, initial base deficit and systolic blood pressure were factors related to mortality. When patients who underwent angiography and embolization only were compared with patients who underwent re-embolization or additional procedure after the first embolization, an increase in systolic blood pressure after embolization was a prognostic factor for successful control of bleeding.; Summary

CT Based Hemoperitoneum Scoring for Clinicians: Objectifying the Severity of Splenic Injury and Recovery: Hong Kyung Shin, Ra Yeong Song, Ho Seong Han, Yoo Seok Yoon, Jai Young Cho, Dae Wook Hwang, Kyuwhan Jung, Young Ki Kim, Woo Hyung Lee; J Trauma Inj. 2013;26(4):273-278.

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Abstract PDF: PURPOSE
In patients with splenic trauma, Computed Tomography (CT) scan is helpful in selecting treatment options and evaluating resolution after NOM (Non-Operative Management). The purpose of this study was to suggest a CT based hemoperitoneum (HP) scoring system that can easily be used by clinicians to evaluate the severity of injury and recovery.
METHODS
A retrospective review of patients with splenic trauma admitted to our hospital between May 2003 and January 2013 was conducted. Patients diagnosed with isolated spleen injury who had a CT scan on admission were included. 1 or 2 points were given according to location and amount of hematoma in the CT image. Using the existing ultrasonography (US) based HP scoring system, the same method was applied to obtain our CT based HP scoring (CBHS) system, which ranges from 0 to 8 points. The CBHS system can be easily used by clinicians for a quick assessment of splenic injury.
RESULTS
Of the 39 patients meeting the inclusion criteria, 6 patients were managed operatively and 33 non-operatively. There was a significant difference in CBHS between the OM (operative management) group and the NOM group.(p=0.03) CBHS showed correlation with Hb (hemoglobin), Hct (hematocrit), spleen injury grade(AAST), and Hounsfield unit of ROI (Region of interest). (p=0.17, p=0.18, p<0.000, p=0.02, respectively) After successful NOM with stabilized Hb level, the amount of hemoperitoneum was scored in the follow-up CT. CBHS demonstrated correlation with decreased spleen injury grade, decreased Hounsfield unit of ROI (Region of interest) (p=0.039, p=0.049, respectively), and also objectively reflected patient recovery.
CONCLUSION
CBHS can be used as an objective and intuitive tool for clinicians in grading the severity of splenic injury by scoring the amount of hemoperitoneum, and in assessing recovery.; Summary

Case Reports

Traumatic Rupture of a Hepatic Hemangioma: Ji Eun Sung, Sang Jun Park, Chang Woo Nam, Jae Chol Hwang, Young Min Kim; J Trauma Inj. 2013;26(3):252-254.

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Abstract PDF: A hepatic hemangioma is the most frequent benign liver tumor. Once rupture occurs, the bleeding can barely be controlled by using conservative management or endovascular treatment. We report a case of traumatic hepatic hemangioma rupture. A 60-year-old man was referred to our hospital under cardiopulmonary cerebral resuscitation (CPCR). CPCR was continued for 16 minutes after his admission to the emergency room (ER). Computed tomography (CT) showed fluid accumulation in the peritoneal cavity with active contrast extravasation in the left lateral segment of the liver. Percutaneous transarterial embolization and massive transfusion were carried out. Embolization did not stop the bleeding, we decided on an exploration and then resected the lateral segment of the liver to control the bleeding. The specimen showed a ruptured hemangioma in the liver segment.; Summary

Delayed Traumatic Intracerebral Hemorrhage in Patient with Hemoperitoneum Operation: Sohyun Kim, Keumseok Bae, Jinsu Pyen, Jongyun Kim, Sungmin Cho, Hany Noh, Kum Whang, Jiwoong Oh; J Trauma Inj. 2013;26(3):233-237.

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Abstract PDF: Delayed traumatic intracerebral hemorrhage (DT-ICH) is a rare event in head trauma patients. However, it develops unexpectedly and results in very severe brain damage. Thus, close monitoring of the neurologic status is needed for every trauma patient. Sometimes, however, neurologic monitoring cannot be done because of sedation, especially in cases of abdominal surgery. In this case report, we describe the case of a 37-yr-old, male patients who had hemoperitoneum because of spleen and renal injury. At the initial operation, massive bleeding was found, so gauze-packing surgery was done first. After the first operation, we sedated the patient for about two days, after which the packed gauze was removed, and the abdominal wound was closed. Immediately after the second operation, we found pupil dilation. Emergent CT was performed. The CT revealed DT-ICH with severe brain edema and midline shifting. However, the patient condition deteriorated progressively despite emergency operation, he expired 2 days after hematoma evacuation.; Summary

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