Journal of Trauma and Injury

Case Reports

Exercise-induced traumatic muscle injuries with active bleeding successfully treated by embolization: three case reports: Yoonjung Heo, Hye Lim Kang, Dong Hun Kim; J Trauma Inj. 2022;35(3):219-222. Published online September 28, 2022; DOI: https://doi.org/10.20408/jti.2022.0028

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Muscle injuries caused by indirect trauma during exercise are common. Most of these injuries can be managed conservatively; however, further treatment is required in extreme cases. Although transcatheter arterial embolization is a possible treatment modality, its role in traumatic muscle injuries remains unclear. In this case series, we present three cases of exercise-induced muscle hemorrhage treated by transcatheter arterial embolization with successful outcomes. The damaged muscles were the rectus abdominis, adductor longus, and iliopsoas, and the vascular injuries were accessed via the femoral artery during the procedures.

Summary

Citations

Citations to this article as recorded by

Thermal and Magnetic Dual-Responsive Catheter-Assisted Shape Memory Microrobots for Multistage Vascular Embolization
Qianbi Peng, Shu Wang, Jianguo Han, Chenyang Huang, Hengyuan Yu, Dong Li, Ming Qiu, Si Cheng, Chong Wu, Mingxue Cai, Shixiong Fu, Binghan Chen, Xinyu Wu, Shiwei Du, Tiantian Xu
Research.2024;[Epub] CrossRef

Severe Airway Obstruction due to Massive Retropharyngeal Hematoma in a Warfarin-Taking Patient with a Normal International Normalized Ratio: Hyun Young Cho, Hyung Il Kim; J Trauma Inj. 2021;34(1):57-60. Published online January 14, 2021; DOI: https://doi.org/10.20408/jti.2020.0028

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Abstract PDF: Warfarin is used as part of the treatment of various diseases, and laboratory monitoring of its effects is required. Airway hematoma secondary to warfarin is rare, but can be fatal because of potential airway obstruction. Rapid definitive airway establishment is crucial if airway obstruction is suspected. This complication is more likely to occur in those with elevated coagulation laboratory values. However, we experienced a patient in whom a massive retropharyngeal hematoma caused airway obstruction after a non-severe motor vehicle collision. The patient had been taking warfarin, and had coagulation parameter values within the normal ranges. A major fracture or hemorrhage was not anticipated. Upon examination, a massive retropharyngeal hematoma was noted. Orotracheal intubation failed due to an airway obstruction. Emergency tracheostomy and an operation for hematoma removal were performed. Physicians must always consider the possibility of airway hematoma in warfarin-taking patients with normal coagulation values regardless of the severity of mechanism of injury; Summary

Hidden Hematologic Disease in Trauma Patients: A Report of Two Cases: Sung Woo Jang, Pil Young Jung; J Trauma Inj. 2020;33(2):112-118. Published online June 17, 2020; DOI: https://doi.org/10.20408/jti.2020.016

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Abstract PDF: In trauma patients, coagulopathy and abnormal increases or decreases in cell counts are frequently observed, and are associated with high mortality and morbidity in the acute phase of trauma. Because major trauma is often life-threatening, and hematologic abnormalities are multi-factorial and transient, major blood loss is usually suspected to be the primary cause of these abnormalities, and much time and cost may be spent attempting to identify a focus of hemorrhage that might or might not actually exist. Persistent abnormalities in the complete blood count, however, require clinical suspicion of other hematologic diseases to minimize improper transfusions and to improve outcomes, including mortality. Physicians at trauma centers should be familiar with the clinical characteristics of hematologic diseases and should consider these diseases in trauma patients. In this report, we present cases of two hematologic disorders found in trauma patients: autoimmune hemolytic anemia induced by systemic lupus erythematosus and myelodysplastic syndrome.; Summary

Original Articles

Immediate Post-laparotomy Hypotension in Patients with Severe Traumatic Hemoperitoneum: Gil Jae Lee, Min A Lee, Byungchul Yoo, Youngeun Park, Myung Jin Jang, Kang Kook Choi; J Trauma Inj. 2020;33(1):38-42. Published online March 30, 2020; DOI: https://doi.org/10.20408/jti.2020.014

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Abstract PDF: Purpose
Immediate post-laparotomy hypotension (PLH) is a precipitous drop in blood pressure caused by a sudden release of abdominal tamponade after laparotomy in cases of severe hemoperitoneum. The effect of laparotomy on blood pressure in patients with significant hemoperitoneum is unknown.
Methods
In total, 163 patients underwent laparotomy for trauma from January 1, 2013 to December 31, 2015. Exclusion criteria included the following: negative laparotomy, only a hollow viscous injury, and hemoperitoneum <1,000 mL. After applying those criteria, 62 patients were enrolled in this retrospective review. PLH was defined as a decrease in the mean arterial pressure (MAP) ≥10 mmHg within 10 minutes after laparotomy.
Results
The mean estimated hemoperitoneum was 3,516 mL. The incidence of PLH was 23% (14 of 62 patients). The MAP did not show significant differences before and after laparotomy (5 minutes post-laparotomy, 67.5±16.5 vs. 68.3±18.8 mmHg; p=0.7; 10 minutes post-laparotomy, 67.5±16.5 vs. 70.4±18.8 mmHg; p=0.193). The overall in-hospital mortality was 24% (15 of 62 patients). Mortality was not significantly higher in the PLH group (two of 14 [14.3%] vs. 13 of 48 [27.1%]; p=0.33). No statistically significant between-group differences were observed in the intensive care unit and hospital stay.
Conclusions
PLH may be less frequent and less devastating than it is often considered. Surgical hemostasis during laparotomy is important. Laparotomy with adequate resuscitation may explain the equivalent outcomes in the two groups.; Summary

Comparison of the Surgical Approaches for Frontal Traumatic Intracerebral Hemorrhage: Eun Sung Park, Seong Keun Moon, Ki Seong Eom; J Trauma Inj. 2019;32(2):71-79. Published online June 30, 2019; DOI: https://doi.org/10.20408/jti.2019.002

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Abstract PDF

Purpose

Recent developments in minimally invasive techniques have the potential to reduce surgical morbidity, promote patient recovery, accelerate surgical procedures, and thus improve cost-effectiveness in case management. In this study, we compared the treatment efficacy and results of supraorbital keyhole approach (SOKA) with those of conventional unilateral frontal craniotomy (CUFC) for traumatic intracerebral hemorrhage (TICH) in the frontal lobe.

Methods

We analyzed the data of 38 patients who underwent CUFC (n=30) and SOKA (n=8) and retrospectively reviewed their medical records and radiological findings. Furthermore, we tried to identify the best surgical method for such lesions by including patients who underwent burr hole aspiration and drainage (BHAD) (n=9) under local anesthesia due to various circumstances.

Results

The difference in the initial Glasgow coma scale score, operative time, and length of hospitalization between the CUFC and SOKA were statistically significant. All radiological features between the two groups including associated skull fracture, amount of pre- and postoperative hematoma, percentage of complete hematoma removal, pre- and postoperative midline shifting of the hematoma, and development of postoperative delayed hematoma were not statistically significant. Our experience of 46 patients with TICH in the frontal lobe with any of the three different surgical methods including BHAD enabled us to obtain valuable findings.

Conclusions

Although it is difficult to insist that one particular approach is more useful than the other, we are confident that SOKA will have more advantages over CUFC in carefully selected patients with frontal TICH depending on the surgical experience of a neurosurgeon.

Summary

Citations

Citations to this article as recorded by

A Study to Evaluate Prognostic Factors and Define a Critical Volume for Early Surgery in Patients with Bifrontal Brain Contusions
Manoranjitha Kumari M, T.P. Jeyaselva Senthilkumar, Yamunadevi Ravi
Indian Journal of Neurosurgery.2024; 13(01): 044. CrossRef
Applications of supraorbital keyhole craniotomy in pediatric cranial trauma: illustrative series of two cases and systematic literature review
Joshua J. Loya, Chenyi Yang, Zach Pennington, Nolan J. Brown, Ali I. Rae, Jesse L. Winer
Child's Nervous System.2023; 39(12): 3531. CrossRef
Supraorbital eyebrow approach: A single-center experience
Blessing Ndlovu, Mohammed Ouwais Abdul Sattar, Mlamuli Mzamo Mkhaliphi, Keletso Leola, Morena Nthuse Mpanza, John Richard Ouma, Christos Profyris
Surgical Neurology International.2022; 13: 566. CrossRef
Re: Comparison of the Surgical Approaches for frontal Traumatic Intracerebral Hemorrhage
Luis Rafael Moscote-Salazar, Ezequiel Garcia-Ballestas, Pradeep Chouksey, Amit Agrawal
Journal of Trauma and Injury.2020; 33(1): 59. CrossRef

Case Reports

Internal Iliac Artery Ligation with Pad Packing for Hemodynamic Unstable Open Comminuted Sacral Fracture: Sung Kyu Kim, Yun Chul Park, Young Goun Jo, Wu Seong Kang, Jung Chul Kim; J Trauma Inj. 2017;30(4):238-241. Published online December 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.4.238

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Abstract PDF

A 52-year-old man experienced blunt trauma upon falling from a height of 40 m while trying to repair the elevator. The patient’s systolic blood pressure and hemoglobin levels were 60 mmHg and 7.0 g/dL, respectively, upon admission. A large volume of bloody discharge was observed in the open wound of the perianal area and sacrum. A computed tomography scan revealed an open comminuted sacral fracture with multiple contrast blushes. He underwent emergency laparotomy. Both internal iliac artery ligations were performed to control bleeding from the pelvis. Protective sigmoid loop colostomy was performed because of massive injury to the anal sphincters and pelvis. Pad packing was performed for a sacral open wound and perineal wound at the prone position. After resuscitation of massive transfusion, he underwent the second operation 2 days after the first operation. The pad was removed and the perineal and sacral open wounds were closed. After the damage-control surgery, he recovered safely. In this case, the hemodynamically unstable, open comminuted sacral fracture was treated safely by internal iliac artery ligation with pad packing.

Summary

Citations

Citations to this article as recorded by

Penetrating sacral injury with a metallic pipe: a case report and literature review
Mahnjeong Ha, Kyoung Hyup Nam, Jae Hun Kim, In Ho Han
Journal of Trauma and Injury.2022; 35(2): 131. CrossRef

Temporary Closure for Sternotomy in Patient with Massive Transfusion Might Be Lethal: Maru Kim, Joongsuck Kim, Sung Jeep Kim, Hang Joo Cho; J Trauma Inj. 2017;30(1):12-15. Published online March 31, 2017; DOI: https://doi.org/10.20408/jti.2017.30.1.12

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Abstract PDF: A 58-year-old male visited our emergency room for multiple traumas from explosion. On initial evaluation, hemopneumoperitoneum with liver laceration (grade 4) and colon perforation was identified. Hemopericardium with cardiac tamponade was also identified. Shrapnel was detected in the right ventricle. Damage control surgery was planned due to condition of hypotension. In operation room, control over bleeding was achieved after sternotomy, pericardiotomy, and laparotomy. Massive transfusion was done during operation. After gauze packing, operation was terminated with temporary closure (TC). Sanguineous fluid was drained profusely. Disseminated intravascular coagulopathy was confirmed through laboratory findings. No extravasation was discovered at hepatic angiogram. On re-operation, there was no active bleeding but oozing from sternotomy site was identified. Bone bleeding was impossible to control. Finally, reoperation was ended after gauze packing and TC all over again. The patient could survive for only a day after re-operation.; Summary

Original Article

Blush on Computed Tomography and Transcatheter Arterial Embolization in Pelvic Fracture: Jihun Gwak, Yong Cheol Yoon, Min A Lee, Byungchul Yu, Myung Jin Jang, Kang Kook Choi; J Trauma Inj. 2016;29(4):161-166. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.161

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Abstract PDF: PURPOSE
Bleeding is the primary cause of death after severe pelvic fracture. Transcatheter arterial embolization (TAE) is the mainstay of treatment for arterial bleeding. This study aimed to determine the frequency of bleeding by angiography of blush-positive pelvic fractures on computed tomography (CT) images. The bleeding arteries that were involved were investigated by pelvic angiography.
METHODS
This retrospective cohort study evaluated 83 pelvic fracture patients who were treated in the intensive care unit of the author's trauma center between January 01, 2013 and April 30, 2015.
RESULTS
Overall mortality was 9 of 83 patients (10.8%). Blush was observed in 37 patients; blush-positive patients had significantly higher mortality (24.3%) than blush-negative patients (0%). Twenty-four of the 83 patients (28.9%) underwent pelvic angiography. Bleeding was showed in 22 of 24 patients in pelvic angiography. TAE was successfully performed in 21 (95.5%) of the bleeding 22 patients. Angiography was performed in 23 of 37 blush-positive patients, and arterial bleeding was identified in 21 (91.3%). A total 33 bleeding arteries were identified in 22 angiography-positive patients. The most frequent origin of bleeding was internal iliac artery (69.7%) followed by the external iliac artery (18.2%) and lumbar arteries (12.1%).
CONCLUSION
The vascular blush observed in CT scans indicates sites of ongoing bleeding in pelvic angiography. TAE is an excellent therapeutic option for arterial bleeding and has a high success rate with few complications.; Summary

Case Report

Pelvic Bone Fracture with Preperitoneal Hemorrhage: Joong Suck Kim, Young Hoon Sul, Seung Je Go, Jin Bong Ye, Sang Soon Park, Gwan Woo Ku, Yeong Cheol Kim; J Trauma Inj. 2015;28(4):272-275. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.272

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Abstract PDF: Pelvic bone fracture with unstable vital signs is a life-threatening condition demanding proper diagnosis and immediate treatment. Unlike long bones, the pelvic bone is a three dimensional structure with complex holes and grooves for vessels and nerves. Because of this complexity, a pelvic bone fracture can lead to complicated and serious bleeding. We report a case of a fifty-year-old male suffering from a pelvic bone fracture due to a fall. An imaging study showed fractures of both the superior and the inferior ramus of the pubic bone, with contrast extravasation underneath them, resulting in a large preperitoneal hematoma. He was sent for angiography, which revealed a hemorrhage from a branch of the left obturator artery. Embolization was done with a glue and lipiodol mixture. The patient recovered without complication, and was discharged at four weeks after admission.; Summary

Original Article

Assessment of the Clinical and the Radiological Prognostic Factors that Determine the Management of a Delayed, Traumatic, Intraparenchymal Hemorrhage (DTIPH): Je Il Ryu, Choong Hyun Kim, Jae Min Kim, Jin Hwan Cheong; J Trauma Inj. 2015;28(4):223-231. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.223

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Abstract PDF: PURPOSE
Delayed, traumatic, intraparenchymal hemorrhage (DTIPH) is a well-known contributing factor to secondary brain damage that evokes severe brain edema and intracranial hypertension. Once it has occurred, it adversely affects the patient's outcome. The aim of this study was to evaluate the prognosis factors for DTIPH by comparing clinical, radiological and hematologic results between two groups of patients according to whether surgical treatment was given or not.
METHODS
The author investigated 26 patients who suffered DTIPH during the recent consecutive five-year period. The 26 patients were divided according to their having undergone either a decompressive craniectomy (n=20) or continuous conservative treatment (n=6). A retrospective investigation was done by reviewing their admission records and radiological findings.
RESULTS
This incidence of DTIPH was 6.6% among the total number of patients admitted with head injuries. The clinical outcome of DTIPH was favorable in 9 of the 26 patients (34.6%) whereas it was unfavorable in 17 patients (65.4%). The patients with coagulopathy had an unexceptionally high rate of mortality. Among the variables, whether the patient had undergone a decompressive craniectomy, the patient's preoperative clinical status, and the degree of midline shift had significant correlations with the ultimate outcome.
CONCLUSION
In patients with DTIPH, proper evaluation of preoperative clinical grading and radiological findings can hamper deleterious secondary events because it can lead to a swift and proper decompressive craniectomy to reduce the intracranial pressure. Surgical decompression should be carefully selected, paying attention to the patient's accompanying injury and hematology results, especially thrombocytopenia, in order to improve the patient's neurologic outcomes.; Summary

Case Reports

A Fatal Intracerebral Hemorrhage Complicated by Compartment Syndrome of the Upper Arm: In Bo Han, Young Sun Chung, Dong Eun Shin, Ryoong Huh, Sang Sup Chung, Jung Yong Ahn; J Korean Soc Traumatol. 2006;19(2):178-182.

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Abstract PDF: Compartment syndrome has a wide spectrum from muscle pain to a life-threatening condition, such as acute renal failure and disseminated intravascular coagulation (DIC). Intracerebral hemorrhage (ICH) due to compartment syndrome has not been reported. We report a patient who presented with ICH leading to death. A 25-year-old female with no significant past history developed extensive compartment syndrome followed by rhabdomyolysis, acute renal failure, DIC, and ICH. Although the patient underwent a fasciotomy and hemodialysis and received aggressive resuscitation with massive transfusions of blood and intravenous fluids, she died. This case stresses the importance of early diagnosis and prompt treatment of compartment syndrome to prevent devastating complications.; Summary

Traumatic Spinal Subdural Hematoma Accompanying intracranial hematoma: Spontaneous Resolution after Pumbar Puncture: Won Tae Lee, Seok Won Kim; J Korean Soc Traumatol. 2006;19(1):93-96.

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Abstract PDF: A traumatic spinal subdural hematoma is a rare condition, and only nine cases have been reported until now. We report a rare case of concomitant intracranial hemorrhage and spinal subdural hematoma with a review of the literature. A 45-year-old man was referred to our institute after being stroke by a car. He complained of nausea, headache, back pain, and bilateral sciatica. Brain computed tomography and lumbar spine magnetic resonance images revealed both an intracerbral hemorrhage and a subdural hematoma in the L4 to S1 level. After performing a lumbar spinal puncture and draining the hemorrhagic cerebrospinal fluid (CSF), the intracranial and spinal hematomas were resolved completely without any neruologic deficits.; Summary

Original Articles

The Relationship Between Type and Size of Scalp Injury and Intracranial Injury Among Patients who Visited the Emergency room due to head Trauma: Yong Sung Kim, Hoon Lim, Young Soon Cho, Ho Jung Kim; J Korean Soc Traumatol. 2006;19(1):8-13.

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Abstract PDF: PURPOSE
Traumatic head injury is very common in the emergency room. Early diagnosis and treatment can significantly reduce mortality and morbidity. When diagnosis is delayed, however, it could be critical to the patients. In reality, it is difficult to take a brain CT for all patients with head trauma, so this study examined the relationship between type and size of scalp injury and intracranial injury.
METHODS
This prospective study was conducted from May 2005 to July 2005. The participants were 193 patients who had had a brain CT. Head trauma included obvious external injury or was based on reports of witnesses to the accident. Children under three years of age were also included if there was a witness to the accident. The size of the injury was measured based on the maximum diameter.
RESULTS
Out of the total of 193 patients, patients with scalp bleeding totaled 126 (65.2%), and patients without scalp bleeding totaled 67 (34.8%). Among patients with scalp bleeding, patients with intracranial injuries numbered nine, and among patients without scalp bleeding, patients with intracranial injuries numbered 17 (P=0.001). Among patients who showed evidence of scalp swelling with no scalp bleeding, the relationship between the size of the scalp swelling and intracranial injury was statistically significant when the size of the scalp swelling was between 2 cm and 5 cm.
CONCLUSION
Among patients who visit an emergency medical center due to traumatic head injury, patients with no scalp bleeding, but with scalp swelling between 2 cm and 5 cm, should undergone more accurate and careful examination, as well as as a brain CT.; Summary

Analysis of the Prognostic Factors in Trauma Patients with Massive Bleeding: Seok Ho Choi, Gil Joon Suh, Yeong Cheol Kim, Woon Yong Kwon, Kook Nam Han, Kyoung Hak Lee, Soo Eon Lee, Seung Je Go; J Trauma Inj. 2012;25(4):247-253.

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Abstract PDF: PURPOSE
Hemorrhage is a main cause of death in trauma patients. The goal of this study is to describe the characteristics of trauma patients with massive bleeding and to evaluate the prognostic factors concerning their survival.
METHODS
This study was performed retrospectively and included trauma patients with massive bleeding who had been treated from March 2007 to August 2012. The inclusion criterion was patients who received more than 10 U of packed red blood cells within the first 24 hours after visiting the emergency department. Based on their medical records, we collected data in terms of demographic findings, mechanisms of injury, initial clinical and laboratory findings, methods for hemostasis (emergency surgery and/or angioembolization), transfusion, injury severity score (ISS), revised trauma score (RTS) and trauma and injury severity score (TRISS). We used the Mann-Whitney U test and Fisher's exact test to compare the variables between the patients that survived and those that did not. We performed a logistic regression analysis with the significant variables from the univariate test.
RESULTS
Thirty-two(32) patients were enrolled. The main mechanisms of injury were falls and motor vehicle accidents. The mean transfusion amount of packed red blood cells (PRBC) was 17.4 U. The mean elapsed time for the first hemostasis (surgery or embolization) was 3.5 hours. The initial technical success rates were 83.3%(15/18) in angioembolization and 66.7%(8/12) in surgery. The overall mortality rate was 34.4%(11/32). The causes of death were bleeding, brain swelling and multiple organ failure. The ISS(25.5 vs 46.3, p=0.000), TRISS(73.6 vs 45.1, p=0.034) and base excess(<-12 mmol/L, p=0.020) were significantly different between the patients who survived and those who did not.
CONCLUSION
The ISS was a prognostic factor for trauma patients with massive bleeding.; Summary

Case Report

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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