SUCCESSFUL MANAGEMENT OF HEMORRHAGIC SHOCK FROM HIGHEST INTERCOSTAL ARTERY INJURY DUE TO BLUNT CHEST TRAUMA USING COMBINED DAMAGE CONTROL SURGERY AND INTERVENTIONAL RADIOLOGY

Abstract

　　We report a case of hemorrhagic shock secondary to injury to the highest intercostal artery caused by severe blunt chest trauma, which was successfully treated using damage-control surgery and interventional radiology (DC-IR). A 64-year-old woman who underwent pulmonary resection and definitive thoracotomy developed recurrent hemorrhagic shock 2 hours postoperatively. Contrast-enhanced computed tomography revealed a new injury to the highest intercostal artery and a massive hemothorax, both of which may contribute to progressive coagulopathy. Using DC-IR, we performed rapid re-thoracotomy and compression hemostasis concurrently with highest intercostal artery embolization. After embolization, the patient was transferred to the intensive care unit with gauze packing and temporary thoracic closure to manage intercostal artery backflow. Blunt injuries of the highest intercostal artery are rare. The combined use of DC-IR and gauze packing was effective due to the anatomical characteristics of the injury and the presence of associated coagulopathy. This report highlights the potential efficacy of intraoperative interventional radiology combined with gauze packing for rapid and effective hemostasis and management of blunt highest intercostal artery injuries accompanied by hemorrhagic shock.