Journal of Trauma and Injury

Case Reports

An unstable patient with a large sucking chest wound managed with gauze packing for preventing tension and bleeding control before surgery in Korea: a case report: Chang-Sin Lee, Min-Jeong Cho, Tae-Wook Noh, Nak-Jun Choi, Jun-Min Cho; Received September 18, 2023 Accepted November 29, 2023 Published online February 23, 2024; DOI: https://doi.org/10.20408/jti.2023.0066 [Epub ahead of print]

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Abstract PDF: This case report describes the management of a 51-year-old female patient who arrived at the emergency room with a stab wound to the upper right chest. Immediate medical interventions were undertaken, including blood transfusions and endotracheal intubation. To prevent tension and control bleeding, gauze packing was applied directly through the large open wound. Further surgical exploration identified a laceration in the lung, necessitating a right upper lobe resection. Postoperatively, the patient's vital signs stabilized, and she was subsequently discharged without complications. This case highlights the decision-making process in selecting between an emergency department thoracotomy and an operating room thoracotomy for patients with penetrating chest trauma. It also illustrates the role of gauze packing in managing tension and hemorrhage. In summary, gauze packing can be an effective interim measure for stabilizing patients with traumatic injuries, unstable vital signs, and large open chest wounds, particularly when a chest tube is already in place, to prevent tension and facilitate bleeding control prior to surgical intervention.; Summary

Penetrating chest trauma from a “less lethal” bean bag in the United States: a case report: Gloria Sanin, Gabriel Cambronero, Megan E. Lundy, William T. Terzian, Martin D. Avery, Samuel P. Carmichael II, Maggie Bosley; J Trauma Inj. 2023;36(4):421-424. Published online September 5, 2023; DOI: https://doi.org/10.20408/jti.2023.0021

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Abstract PDF: This case report presents the case of a 49-year-old man who presented to our level I trauma center after sustaining injuries in an altercation with local law enforcement in which he was shot with a less lethal bean bag and tased. In a primary survey, a penetrating left supraclavicular wound was noted in addition to a taser dart lodged in his flank. No other traumatic findings were noted in a secondary survey. Given hemodynamic stability, completion imaging was obtained, revealing a foreign body in the left lung, a left open clavicle fracture, a C5 tubercle fracture, a possible grade I left vertebral injury, and a left first rib fracture. Soft tissue gas was seen around the left subclavian and axillary arteries, although no definitive arterial injury was identified. The bean bag projectile was embedded in the parenchyma of the left lung on cross-sectional imaging. The patient underwent thoracotomy for removal of the projectile and hemostasis. A thoracotomy was chosen as the operative approach due to concerns about significant bleeding upon foreign body removal. A chest tube was placed and subsequently removed on postoperative day 5. The patient was discharged on postoperative day 7. At a 2-week outpatient follow-up visit, the patient was doing well. This case report is the first to describe this outcome for a drag-stabilized bean bag. Although law enforcement officers utilize bean bag projectiles as a “less lethal” means of crowd control and protection, these ballistics pose significant risk and can result in serious injury.; Summary

Isolated penetrating gluteal stab injury with uncontrolled bleeding in Türkiye: a case report: Ali Metehan Celep, Görkem Yiğit, Ayla Ece Çelikten, Kudret Atakan Tekin, Ufuk Türkmen; J Trauma Inj. 2023;36(4):454-457. Published online August 8, 2023; DOI: https://doi.org/10.20408/jti.2023.0010

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Abstract PDF: Arterial injuries in the gluteal region caused by a knife are rare but serious, with mortality rates of up to 25%. This case report presents the management of a young male patient admitted to the emergency department in hypovolemic shock, with uncontrollable bleeding from an isolated penetrating gluteal injury. Additionally, the details of the surgical approach employed are discussed.; Summary

Penetrating right ventricular injury following a single gunshot to the left flank in Iraq: a case report: Zryan Salar Majeed, Yad N. Othman, Razhan K. Ali; J Trauma Inj. 2023;36(3):253-257. Published online April 19, 2023; DOI: https://doi.org/10.20408/jti.2022.0073

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Abstract PDF: A century ago, cardiac injuries usually resulted in death. However, despite all the advances in medicine, these injuries still have high mortality and morbidity rates. In the present case, we describe a patient with a bullet injury to the right ventricle who survived at our hospital despite the limitations of our center with regard to modalities and equipment. A 30-year-old man was brought to our emergency department with a bullet wound to his left flank. He was hemodynamically unstable. After only 8 minutes in the hospital and without further investigations he was rushed to the operating room. During laparotomy, a clot was visible in the left diaphragm, which dislodged and caused extensive bleeding. The decision was made to perform a sternotomy in the absence of a sternal saw. An oblique 8-cm injury to the right ventricle was discovered following rapid exploration. It was repaired without the need for cardiopulmonary bypass surgery. After a few days in the hospital, the patient was discharged home. In the event of a penetrating cardiac injury, rapid decision-making is crucial for survival. Whenever possible, the patient should be transferred to the operating room, as emergency department thoracotomies are associated with a high mortality rate.; Summary

Original Article

Epidemiology and outcomes of patients with penetrating trauma in Incheon Metropolitan City, Korea based on National Emergency Department Information System data: a retrsopective cohort study: Youngmin Kim, Byungchul Yu, Se-Beom Jeon, Seung Hwan Lee, Jayun Cho, Jihun Gwak, Youngeun Park, Kang Kook Choi, Min A Lee, Gil Jae Lee, Jungnam Lee; J Trauma Inj. 2023;36(3):224-230. Published online December 21, 2022; DOI: https://doi.org/10.20408/jti.2022.0055

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Abstract PDF: Purpose
Patients with penetrating injuries are at a high risk of mortality, and many of them require emergency surgery. Proper triage and transfer of the patient to the emergency department (ED), where immediate definitive treatment is available, is key to improving survival. This study aimed to evaluate the epidemiology and outcomes of patients with penetrating torso injuries in Incheon Metropolitan City.
Methods
Data from trauma patients between 2014 and 2018 (5 years) were extracted from the National Emergency Department Information System. In this study, patients with penetrating injuries to the torso (chest and abdomen) were selected, while those with superficial injuries were excluded.
Results
Of 66,285 patients with penetrating trauma, 752 with injuries to the torso were enrolled in this study. In the study population, 345 patients (45.9%) were admitted to the ward or intensive care unit (ICU), 20 (2.7%) were transferred to other hospitals, and 10 (1.3%) died in the ED. Among the admitted patients, 173 (50.1%) underwent nonoperative management and 172 (49.9%) underwent operative management. There were no deaths in the nonoperative management group, but 10 patients (5.8%) died after operative management. The transferred patients showed a significantly longer time from injury to ED arrival, percentage of ICU admissions, and mortality. There were also significant differences in the percentage of operative management, ICU admissions, ED stay time, and mortality between hospitals.
Conclusions
Proper triage guidelines need to be implemented so that patients with torso penetrating trauma in Incheon can be transferred directly to the regional trauma center for definitive treatment.; Summary

Case Reports

Experience and successful treatment of craniocerebral gunshot injury at a regional trauma center in Korea: a case report and literature review: Mahnjeong Ha, Seunghan Yu, Jung Hwan Lee, Byung Chul Kim, Hyuk Jin Choi; J Trauma Inj. 2022;35(4):277-281. Published online November 22, 2022; DOI: https://doi.org/10.20408/jti.2022.0057

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Abstract PDF: Craniocerebral gunshot injuries is gradually increasing in the civilian population with a worse prognosis than closed head trauma. We experienced a case of craniocerebral gunshot injury which a bullet penetrating from the submandibular area into the clivus of a patient. The patient did not show any symptom. However, serial laboratory findings showed an increase in blood lead level. We removed foreign bodies without any problems using an endoscopic transnasal transclival approach. Due to the extremely low frequency, guidelines for definitive management of gunshot injuries have not been presented in Korea yet. We introduce our surgical experience of a craniocerebral gunshot injury with an unusual approach for removing intracranial foreign bodies.; Summary

Nonoperative management of colon and mesocolon injuries caused by blunt trauma: three case reports: Naa Lee, Euisung Jeong, Hyunseok Jang, Yunchul Park, Younggoun Jo, Jungchul Kim; J Trauma Inj. 2022;35(4):291-296. Published online September 19, 2022; DOI: https://doi.org/10.20408/jti.2022.0009

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Abstract PDF: The therapeutic approach for colon injury has changed continuously with the evolution of management strategies for trauma patients. In general, immediate laparotomy can be considered in hemodynamically unstable patients with positive findings on extended focused assessment with sonography for trauma. However, in the case of hemodynamically stable patients, an additional evaluation like computed tomography (CT) is required. Surgical treatment is often required if prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation are observed. However, immediate intervention in hemodynamically stable patients without indications for surgical treatment remains questionable. Three patients with colon and mesocolon injuries caused by blunt trauma were treated by nonoperative management. At the time of admission, they were alert and their vital signs were stable. Colon and mesocolon injuries, large hematoma, colon wall edema, and/or ischemia were revealed on CT. However, no prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation were observed. In two cases, conservative treatment was performed without worsening abdominal pain or laboratory tests. Follow-up CT showed improvement without additional treatment. In the third case, follow-up CT and percutaneous drainage were performed in considering the persistent left abdominal discomfort, fever, and elevated inflammatory markers of the patient. After that, outpatient CT showed improvement of the hematoma. In conclusion, nonoperative management can be considered as a therapeutic option for mesocolon and colon injuries caused by blunt trauma of selected cases, despite the presence of large hematoma and ischemia, if there are no clear indications for immediate intervention.; Summary

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

Successful management of a common carotid artery injury using a Pruitt-F3 Carotid Shunt: a case report: Kang Kook Choi, Jayun Cho, Min A Lee, Soo Min Eun, Yang Bin Jeon; J Trauma Inj. 2022;35(Suppl 1):S3-S7. Published online May 25, 2022; DOI: https://doi.org/10.20408/jti.2021.0032

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Abstract PDF: Penetrating neck injuries are a surgical challenge. In particular, penetrating neck injuries associated with carotid artery injuries have a high mortality rate. Overt external hemorrhage is unanimously considered as an indication for surgical exploration. The authors present a case of successful surgical management for a penetrating common carotid artery injury using a Pruitt-F3 Carotid Shunt (LeMaitre Vascular Inc., Burlington, MA, USA) in a 60-year-old male patient who was transferred to the level 1 trauma center due to a metal fragment piercing his neck while working. Active pulsatile bleeding was observed from the 3-cm-long external wound on the anterior neck in zone II. Emergent neck exploration showed near-total transection of the left common carotid artery just below the carotid bifurcation. After a Pruitt-F3 Carotid Shunt was applied to the injured carotid artery as a temporary vascular shunt, artificial graft interposition was performed for the injured common carotid artery. The patient experienced cerebral infarction as a complication caused by ischemia-reperfusion of the common carotid artery but was discharged in a suitable state for rehabilitation therapy.; Summary

Penetrating sacral injury with a metallic pipe: a case report and literature review: Mahnjeong Ha, Kyoung Hyup Nam, Jae Hun Kim, In Ho Han; J Trauma Inj. 2022;35(2):131-138. Published online May 11, 2022; DOI: https://doi.org/10.20408/jti.2021.0063

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Abstract PDF: Other than gunshot injuries, sacral penetrating injuries with a foreign body exiting to the other side are extremely rare. We encountered a case of sacral injury in which a long metallic pipe penetrated from the anus into the lower back of a patient. Since the pelvis contains various organs, management of a penetrating injury requires multidisciplinary treatment involving several medical specialties. Due to the infrequency of this type of injury, there are no definitive guidelines for effective management. We described our experience surgically treating a sacral penetrating injury and conducted a literature review. On this basis, we suggest a surgical strategy for treating this type of injury.; Summary

Thoracoabdominal injury with evisceration from a chainsaw assault: a case report: Babatunde Abayomi Salami, Babatunde Adeteru Ayoade, El-Zaki Abdullahi Shomoye, Chigbundu Collins Nwokoro; J Trauma Inj. 2022;35(2):118-122. Published online May 11, 2022; DOI: https://doi.org/10.20408/jti.2021.0012

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Abstract PDF: The usual cause of penetrating thoracoabdominal injuries with evisceration are stab wounds with knives and other sharp weapons used during fights and conflicts. Evisceration of the abdominal viscera as a result of trauma, with its attendant morbidity and mortality, requires early intervention. Gunshot wounds can also cause penetrating thoracoabdominal injuries. We report the case of a 52-year-old male patient, a worker at a timber-processing factory, who was assaulted with a chainsaw by his colleague following a disagreement. He was seen at the accident and emergency department of our hospital with a thoracoabdominal injury about 1.5 hours after the attack. He had a left thoracoabdominal laceration with abdominal evisceration and an open left pneumothorax. He was managed operatively, made a full recovery, and was discharged 16 days after admission. He was readmitted 4 months after the initial surgery with acute intestinal obstruction secondary to adhesions. He underwent exploratory laparotomy and adhesiolysis. He made an uneventful recovery and was discharged on the ninth postoperative day for subsequent follow-up.; Summary

Traumatic abdominal wall hernia with hemoperitoneum caused by blunt injury: laparoscopic exploration with mini-laparotomy repair. A case report: Euisung Jeong, Hyunseok Jang, Younggoun Jo, Yunchul Park, Naa Lee, Jungchul Kim; J Trauma Inj. 2022;35(1):61-65. Published online December 23, 2021; DOI: https://doi.org/10.20408/jti.2021.0062

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1 Citations

Abstract PDF

Traumatic abdominal wall hernia is a very rare clinical entity. Herein, we report the case of a patient who was transferred from a local clinic to the emergency department because of left lower abdominal pain. Initially, an intra-abdominal hematoma was observed on computed tomography and no extravasation was noted. Conservative treatment was initiated, and the patient’s symptoms were slightly relieved. However, though abdominal pain was relieved during the hospital stay, bowel herniation was suspected in the left periumbilical area. Follow-up computed tomography showed traumatic abdominal wall hernia with hemoperitoneum in the abdomen. We performed a laparoscopic exploration of the injury site and hernia lesion. The anterior abdominal wall hernia was successfully closed.

Summary

Citations

Citations to this article as recorded by

Unique laparoscopic emergency management of traumatic obstructed abdominal wall hernia: A case report and review of literature
Arwa M Aljuhani, Ghaith A Al Saied, Arjmand Reyaz, Mohammed A Alkahlan, Ibrahim M Aljohani, Muhammed M Abukhater
International Journal of Abdominal Wall and Hernia.2024;[Epub] CrossRef

Pre-Hospital and In-Hospital Management of an Abdominal Impalement Injury Caused by a Tree Branch: So Ra Ahn, Joo Hyun Lee, Keun Young Kim, Chan Yong Park; J Trauma Inj. 2021;34(4):288-293. Published online December 16, 2021; DOI: https://doi.org/10.20408/jti.2021.0051

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Abstract PDF: In South Korea, most patients who visit trauma centers with abdominal injuries have blunt trauma, and penetrating injuries are relatively rare. In extremely rare cases, some patients are admitted with a long object penetrating their abdomen, and these injuries are referred to as abdominal impalement injuries. Most cases of impalement injuries lead to fatal bleeding, and patients often die at the scene of the accident. However, patients who survive until reaching the hospital can have a good prognosis with optimal treatment. A 68-year-old female patient was admitted to the trauma center with a 4-cm-thick tree branch impaling her abdomen. The patient was transported by a medical helicopter and had stable vital signs at admission. The branch sticking out of the abdomen was quite long; thus, we carefully cut the branch with an electric saw to perform computed tomography (CT). CT revealed no signs of major blood vessel injury, but intestinal perforation was observed. During laparotomy, the tree branch was removed after confirming that there were no vascular injuries, and enterostomy was performed because of extensive intestinal injury. After treating other injuries, the patient was discharged without any complications except colostomy. Abdominal impalement injuries are treated using various approaches depending on the injury mechanism and injured region. However, the most important consideration is that the impaled object should not be removed during transportation and resuscitation. Instead, it should only be removed after checking for injuries to blood vessels during laparotomy in an environment where injury control is possible.; Summary

Dual repair of traumatic flank hernia using laparoscopic and open approaches: a case report: Yoonjung Heo, Dong Hun Kim; J Trauma Inj. 2022;35(1):46-50. Published online October 25, 2021; DOI: https://doi.org/10.20408/jti.2021.0008

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Abstract PDF Supplementary Material: Traumatic flank hernia (TFH) is rare and prone to recurrence, which makes appropriate treatment challenging. No current guidelines define the optimal timing and method of repair. Meanwhile, recent advances in laparoscopic techniques are reshaping the options for the treatment of TFH. A dual approach that utilizes both laparoscopic and open methods has not previously been reported. Herein, we present the successful treatment of TFH after blunt trauma. A 46-year-old male patient underwent elective herniorrhaphy on hospital day 3, in which laparoscopic implantation of a sublay mesh and extracorporeal implantation of an onlay mesh were performed. Such techniques may be appropriate and result in feasible outcomes in hemodynamically stable patients with large TFH who are strongly suspected of having bowel herniation or concomitant intraperitoneal injuries. Larger studies are needed to assess the long-term results.; Summary

Original Article

Indications for Laparotomy in Patients with Abdominal Penetrating Injuries Presenting with Ambiguous Computed Tomography Findings: Eun Ji Choi, Sanghee Choi, Byung Hee Kang; J Trauma Inj. 2021;34(2):112-118. Published online June 8, 2021; DOI: https://doi.org/10.20408/jti.2020.0058

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Abstract PDF: Purpose
Negative laparotomy in patients with abdominal penetrating injuries (APIs) is associated with deleterious outcomes and unnecessary expense; however, the indications for laparotomy in hemodynamically stable patients with ambiguous computed tomography (CT) findings remain unclear. This study aimed to identify the factors associated with negative laparotomy. findings
Methods
Data of patients who underwent laparotomy for APIs between 2011 and 2019 were retrospectively reviewed. Patients who presented with definite indications for laparotomy were excluded. The patients were dichotomized into negative and positive laparotomy groups, and the baseline characteristics, laboratory test results, and CT findings were compared between the groups.
Results
Of 55 patients with ambiguous CT findings, 38 and 17 patients were assigned to the negative and positive laparotomy groups, respectively. There was no significant difference between the groups with respect to the baseline characteristics or the nature of the ambiguous CT findings. However, the laboratory test results showed that there was a difference in the percentage of neutrophils between the groups (negative: 55.6% [range 47.4–66.1%] vs. positive: 79.8% [range 77.6–88.2%], p<0.001), although the total white blood cell count was not significantly different. The mean duration of hospital stay for the negative laparotomy group was 13.1 days, and seven patients (18.4%) experienced complications.
Conclusions
Diagnostic factors definitively indicative of laparotomy were not identified, although the percentage of neutrophils might be helpful. However, routine laparotomy in patients with peritoneal injuries could result in instances of negative laparotomy.; Summary

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