出血性ショックを合併した総頚動脈断裂の１例

抄録

18-year-old man had a motorcycle accident and lay bleeding at the site of the accident. The witness called a local surgeon in the nearby clinic and the surgeon performed hemostasis on the site. After ambulance crew arrived, the surgeon continued to perform hemostasis in answer to demands and rode on an ambulance together to hospital. Following the arrival at our hospital, Emergency Room (ER) physicians, cardiovascular surgeon and neurosurgeon started to treat the patient as soon as possible. Because of con­tinuous bleeding and unstable circulation dynamics, we couldn’t transport him to the operation room and decided to repair the injured artery in ER. Finally, we could suture the injured artery successfully. On the day of operation and 8th day after admission, we performed Digital Subtraction Angiography and confirm no complications like carotid artery stenosis and pseudoaneurysm. On the 15th day, he was discharged from hospital without any neurological deficits.

Blunt common carotid artery injury with hypo­volemic shock is associated with a high mortality rate and extremely low survival rate. We experienced a case of common carotid artery laceration due to the direct application of force to the neck. In this case, early therapeutic intervention by local surgeon and resourceful surgical assessment contributed to suc­cessful resuscitation without no neurological complications. In addition, common carotid artery was easy to approach surgically in ER. This report suggested that challenging surgical interventions in ER were necessary to treat a case of fatal carotid artery injury occasionally.