This retrospective study, including 36 patients with blunt splenic injuries, evaluated whether our classification based on the computed tomography (CT) findings was useful in determining the optimal initial treatment strategy for splenic injury. We defined the CT grading system as follows : Grade 1, splenic injury without extravasation ; Grade 2, with extravasation confined within the splenic parenchyma ; Grade 3, with extravasation that extended into the peritoneal cavity and with a poor-enhancement region in a segment of the parenchyma ; and Grade 4, with extravasation that extended into the peritoneal cavity and with a diffuse poor-enhancement region in the parenchyma. The proportions of CT grades stratified for the different treatment strategies were as follows : conservative treatment : Grade 1, 0% ; Grade 2, 18% ; Grade 3/4, 0% ; trans-catheter arterial embolization (TAE) : Grade 1, 0% ; Grade 2, 11% ; Grade 3, 89% ; Grade 4, 0% ; and laparotomy : Grade 1/2, 0% ; Grade 3, 60% ; Grade 4, 40% (p<0.01). The sensitivity and specificity of a classification higher than Grade 2 for the need for hemostasis were 93% and 100%, respectively. Our findings suggest that this CT grading system would be helpful for determining the optimal initial treatment strategy for blunt splenic trauma.
This research aimed to propose a logistic regression model for Japanese blunt trauma victims. First, we tested whether the logistic regression model previously created from data registered in the Japan Trauma Data Bank (JTDB) between 2005 and 2008 is still valid for the data from JTDB between 2009 and 2013. The model was proved to be highly accurate (94.56%) and valid. We also demonstrated that the model remains valid without respiratory rate (RR) data. In addition, we demonstrated that the model would maintain high accuracy even when its coefficients were rounded off to two decimal places. As a result of our investigation, we propose the equation of survival prediction in Japan to be Ps=1/ (1+e-b) b=-0.76+1.03×Revised Trauma Score-0.07×Injury Severity Score-0.04×age.
A 20-year-old male was admitted to our hospital with the complaint of left lateral abdominal pain following a motorcycle crash. He presented hemorrhagic shock. Contrast-enhanced CT (CE-CT) revealed severe renal trauma and extravasation of contrast medium. On the basis of a clinical diagnosis of hemorrhagic shock with severe renal trauma, we decided to treat the patient with the therapy of interventional radiology (IVR). Three days after the injury, his anemia and abdominal pain became worse, and CE-CT showed extravasation and renal trauma. We performed IVR and a single-J ureteral catheter was inserted. After the therapy, the patient was doing well, so the catheter was removed fourteen days after the injury. However, sixteen days after the injury, CE-CT showed extravasation and renal trauma again, and twenty days after the injury, the patient complained of abdominal pain and CE-CT showed that the renal trauma had worsened. We gave up on the conservative treatment and, twenty-one days after the injury, we undertook an operation to remove his left kidney.
A 22-year-old man was injured in a traffic accident and diagnosed with a type III pancreatic injury. Because his vital signs were stable, transcatheter arterial embolization was performed for bleeding around the pancreatic injury and the decision was made to manage the injury nonoperatively. Because pseudocysts in the injured portion of the pancreas increased over the course of treatment and abdominal symptoms appeared, the case was followed up with a planned pancreatic cystojejunostomy. If prior diagnostic imaging had shown a primary pancreatic duct injury, a laparotomy would have been performed immediately. However, when a patient's condition is stable, even if there is a primary pancreatic duct injury, nonoperative management is feasible.
We report a rare case of super-mesenteric vein thrombosis triggered by blunt abdominal trauma involving a 65-year-old man. He fell seven meters to the ground and was taken to our hospital. Tachycardia, tachypnea, and high fever with an unknown cause appeared from the next day. Computed tomography four days after admission revealed portal and superior mesenteric venous gas, which suggested small bowel necrosis. We performed resection of 380 cm of necrotic ileum with ileostomy and temporary abdominal closure. The next day, a second look operation was performed. Histological examination led to a diagnosis of super-mesenteric vein thrombosis. Since there was a risk of aggravation of intracranial hemorrhage, anticoagulant therapy was postponed. Because computed tomography thirteen days after admission revealed thrombus again, we conducted continuous heparin injection and then converted this to warfarin. The course has been uneventful. Ileostomy was closed 8 months later.
A 29-year-old constructive worker fell onto a steel column and suffered an impalement injury to the perineal region. We performed urgent laparotomy for a hemorrhagic shock state. Laparotomy encountered massive bleeding from zone 3 of the peritoneum. Hemostasis was accomplished with gauze-packing. The abdominal wall remained open with handmade vacuum pack closure (VAC). During the open abdomen and damage control (OA/DC) strategy, prolonged edema of the bowel and small intestinal fistula made it impossible to close the abdomen primarily. On hospital day 19, we placed an orthopedic external fixation device at the open abdominal wall and approached with it by about 2 cm day by day. We successfully closed the abdomen after 8 days. An orthopedic external fixator was effective for the secondary abdominal fascial closure.