[Background] The incidence and course of splenic pseudoaneurysm (SPA) following non-operative management of blunt splenic injury have not been thoroughly examined. The purpose of this study was to clarify the factors associated with the formation and disappearance of SPA. [Method] Between January 2012 and December 2015, 62 patients were diagnosed with splenic injuries, and 52 received non-operative management. Patients were classified based on the presence of SPA formation, (SPA+group) or (SPA-group). Eleven patients in the SPA+group were further classified into two groups, embolization or self-vanishing. [Results] The average injury severity score was significantly lower in the SPA+group (17.18±2.39) than in the SPA-group (25.17±2.9 ; p=0.047). In addition, the number of injury sites, excluding the spleen, was less in the SPA+group (0.72±0.19) compared with in the SPA-group (1.9±0.3 ; p=0.007). No significant difference was found between the embolization-group and the self-vanishing group. [Conclusion] SPAs formed following blunt splenic injury tended to be associated with low-energy trauma and low injury severity scores.
Objective : The present study aimed to validate our strategy for managing penetrating torso injuries. Method : We retrospectively reviewed the clinical records of 50 patients (male, n=36 ; mean age, 53.1 years) who were transferred to our department with penetrating injuries of the torso between April 2010 and December 2014. Results : Upon arrival, 14 patients were in a state of shock and nine underwent emergency surgery due to persistent physiological instability. Although physiological status was stabilized in 41 patients, eight were surgically treated without CT evaluation because the weapon was still in the wound. Wounds that did not reach the thoracic or peritoneal cavity were directly closed in 18 of 33 patients who were assessed by CT. We managed 15 patients with wounds that reached any cavity based on our strategy. Wounds in three patients that reached the thoracic cavity were directly closed after inserting a chest drain. Wounds that reached the peritoneal cavity were approached via laparotomy in 10 of 13 patients. None of the patients died in the hospital and five were managed without surgery. Conclusion : Outcomes based on our strategy were satisfactory for this series of patients.
Objectives : We examined radical treatment for severe trauma when medical treatment was started in the rapid response car or helicopter. Patients and methods : Patients who underwent emergency room abdominal surgery between January 2008 and December 2014 were divided into two groups : conveyance by ambulance alone (ambulance group) or by rapid response car and helicopter dispatch (RRC/DH group). Result : The groups comprised 61 patients. There was no difference in the time from diagnosis to the start of medical treatment between groups, but the time taken to reach the hospital was longer in the RRC/DH group. The time from admission to the start of surgery was shorter in the RRC/DH group (32.5 minutes) than in the ambulance group (62.7 minutes). The times from admission to the start of red blood cell transfusion (29.6 minutes) and fresh frozen plasma transfusion (52.1 minutes) were also shorter in the RRC/DH group, with the ambulance group requiring 50.6 and 104.8 minutes, respectively. The 24-hour survival and survival discharge rates were higher in the RRC/DH group, but this difference was not significant. Conclusion : We may be able to improve the prognosis for severe trauma patients by starting surgery and blood transfusions earlier in a rapid response car or helicopter.
Objective : To investigate the indications for laparotomy for severe abdominal parenchymal organ injuries. Methods : We divided 19 cases of type III hepatic injuries, splenic injuries, or pancreatic injuries that were treated at our hospital from 2011 to 2015 into laparotomy and non-laparotomy groups. Results : Eight cases of hepatic injuries (2 of III a, 6 of III b), 9 cases of splenic injuries (3 of III a, 6 of III b), and 4 cases of pancreatic injuries (2 of III a, 2 of III b) were examined, and laparotomy was required in 10 cases. The indications for laparotomy were refractory shock in 5 cases, suspected abdominal contamination in 3 cases, and penetrating injury in one case. The remaining case involved a combination of type III b hepatic injury and type III a pancreatic injury ; however, the patient's vital signs were stable, making it difficult to judge whether a laparotomy was required. The laparotomy group tended to include more shock-on-arrival cases and have higher injury severity scores, but the differences were not significant. Conclusions : Although most patients that underwent laparotomy exhibited refractory shock or abdominal contamination as complications, possible bile leakage and/or pancreatic fistula formation may also require laparotomy.
We retrospectively examined 50 cases of bear-inflicted injuries transported to Iwate Medical University Emergency and Critical care Center. The patients were mostly male (average age : 69±5 years old), and were often attacked in May from 8 : 00-11 : 59 while picking wild plants. The patients had damage to the facial area in 90% of the cases without bilateral difference, and emergency surgery under general anesthesia was required in 68% of the cases. Prophylactic antibiotics were administered in all cases and the incidence rate for wound infection was 20%. The detected bacteria comprised 11 different strains ; 7 strains of facultative anaerobic bacteria and 4 strains of anaerobic bacteria, and β lactamase inhibitors were effective for 9 of the strains. When the incidence rates for wound infection were based on the given antibiotic, the incidence was 9.1% for β lactamase inhibitors and 28.5% for non-β lactamase inhibitors.
A 57-year-old male was injured by accidental slaughter gun discharge at a fish processing plant. A helicopter ambulance was called. He received tracheal intubation and drain placement in the right thoracic cavity, and was transported to our hospital. II a-type bilateral lung injury (diffuse lung contusion), II a-type thorax injury (sternal fracture), and airway hemorrhage were noted, and artificial respiratory management was initiated. Multiple contusions in the precordium and bilateral forearms were closed with sutures. Perforation of the right tympanum was observed on the 6th hospital day. The lung contusions gradually healed. The patient was weaned from the artificial respiration on the 8th hospital day, and transferred to another hospital for rehabilitation by independent walking on the 22nd hospital day. Physicians in Japan have little experience with blast injuries. Although it was a small-scale explosion, the blast was likely to have caused the tympanum injury and lung contusions. We report this case because it may provide helpful suggestions for the treatment of blast injuries.
A 71-year-old man was injured in an automobile accident and diagnosed with intra-abdominal hemorrhage and severe shock. Laparotomy was performed on a resuscitation table assisted with intra-aortic balloon occlusion. By adjusting the inflation of the intra-aortic balloon, the procedures were easily performed in an operative field with a good view. Hemorrhage from the mesenteric vessels of the small intestine and sigmoid colon was repaired. The patient was discharged without complications. In cases of severe intra-abdominal hemorrhagic shock, adjusting the inflation of the intra-aortic balloon is useful for both resuscitation and to control hemorrhaging.
A 42-year-old man was brought to our trauma center in hemorrhagic shock caused by a motorcycle accident. We diagnosed left diaphragm injury with evisceration into the thoracic cavity, unstable pelvic fracture, and right femur fracture. First, transcatheter arterial embolization and external fixation were performed for the pelvic fractures, and the diaphragm injury was repaired for respiratory stabilization. A computed-tomography scan revealed two thoracic aortic lesions. As we found no extravasation of contrast media, we continued careful observation. On hospital day 16, thoracic endovascular aortic repair (TEVAR) was performed for the isthmus injury. A follow-up computed tomography scan indicated enlargement of the arch injury. Therefore, total arch replacement was performed on hospital day 24. Both TEVAR and thoracotomy are necessary for the management of multiple lesions due to blunt thoracic aortic injury.