The usefulness of venovenous extracorporeal membrane oxygenation (VV-ECMO) has been reported in cases of severe respiratory failure. However, its use has been avoided in trauma cases due the risk of hemorrhage. We retrospectively examined 9 trauma cases in which ECMO was used between April 2007 and March 2018. The patients in 5 cases (55.6%) survived. Although ECMO improved the pH and PaCO2 levels, it was considered to have promoted exsanguination in 2 cases. ECMO may be useful for trauma patients, but it is necessary to preserve the blood volume prior to ECMO and examine the blood return site based on the injury site.
Defining "delayed traumatic pneumothorax (DTPTX) " as traumatic pneumothorax (TPTX) diagnosed by film examination after admission that was not detected by computed tomography at admission, we retrospectively evaluated 159 patients with TPTX due to blunt trauma. Five patients met the criteria for DTPTX. All patients had multiple upper or middle rib fractures, and three also had clavicle fracture. DTPTX was diagnosed on day 2 (80%) or 3 (20%). Emergency thoracic drainage just after the diagnosis was required for 3 of 5 (60%), and 1 of the remaining 2 patients underwent drainage just before elective surgery under general anesthesia. The thoracic drainage duration was 6 (3-11) days and DTPTX in the remaining patient who did not receive drainage did not deteriorate ; therefore, all 5 patients survived. Although DTPTX is rare, as some patients require immediate thoracic drainage, chest trauma patients with multiple upper or middle rib fractures and clavicle fracture should be observed carefully.
Early spinal stabilization cannot be achieved in all patients with polytrauma because some cannot tolerate being placed in the prone position due to the severity of concurrent injuries. We report four patients who were placed in the lateral position due to severe chest injury and who underwent spine fixation using a percutaneous pedicle screw (PPS). The mean ISS score was 46.2 (range, 33-66). We inserted the PPS in the right lateral position using a computed tomography navigation system. The accuracy of screw insertion was 94.4% and there were no neurological side effects. The patients were encouraged to undergo respiratory rehabilitation after fixation. The insertion of a PPS in the lateral position enables early fixation of an injured spine in patients with polytrauma who cannot be placed in the prone position.
Successful treatment of traumatic intraperitoneal bladder rupture (IBR) with conservative management has been reported. We report the laparoscopic repair of spontaneous bladder rupture in a patient diagnosed with IBR after alcohol consumption. He was treated conservatively, including urethral catheter drainage, 2 years prior to presentation. Although conservative management is one of the possible treatments for IBR, such cases warrant close follow-up–particularly of the urination status.
A man in his twenties was transferred to our hospital in shock with splenic injury, thoracic trauma, and pelvic/limb fractures. We performed splenectomy on the same day, followed by open reduction and internal fixation on hospital day 6. His clinical course was good, but on day 14, he developed disturbance of consciousness with high fever, and herpes simplex virus was detected in blisters on his fingers and ear. In addition, brain MRI demonstrated abnormal high-intensity signals. We diagnosed him with herpes simplex infection and acute disseminated encephalomyelitis with disturbance of consciousness. We administered acyclovir, which immediately improved his symptoms. When a patient develops unexplained high fever after splenectomy or treatment for severe trauma, traumatologists need to keep in mind not only bacterial infections but also viral infections such as herpes simplex.
Endoscopic retrograde pancreatography (ERP) is recommended to detect injury of the main pancreatic duct (MPD). We report a case in which ERP was unable to detect penetrating injury of the MPD. A 75-year-old woman stabbed herself in the abdomen. Abdominal CT revealed pancreatic head injury, but ERP demonstrated no injury of the MPD. We performed simple closure of the stomach and peri-pancreatic drainage. Postoperative biliary and pancreatic fistulae were suspected. Therefore, second ERP was carried out, which confirmed injury of the MPD and the common bile duct. After the endoscopic pancreatic stent was inserted, choledochojejunostomy was performed. False-negatives may occur on ERP when assessing penetrating trauma of the MPD. In addition, endoscopic pancreatic stents are useful even for MPD penetrating trauma of the pancreatic head.
A 41-year-old women was admitted to our hospital for seizure. Brain CT revealed subarachnoid hemorrhage (SAH) and digital subtraction angiography demonstrated an aneurysm located in the left internal carotid artery, which was thought to be the cause of SAH. In addition, bilateral cervical internal carotid artery dissections (CICADs) were identified. Clipping of the aneurysm was carried out. CT at 1 day post-procedure demonstrated cerebral infarction. According to her detailed medical story, she had begun chiropractic care 27 days before admission. Chiropractic care was considered to have caused the bilateral CICADs, which in turn caused the thromboembolism and cerebral infarction. Antiplatelet therapy was administered, and she was transferred to the rehabilitation hospital 29 days after admission. MRA at 3 months post-procedure demonstrated improvement of bilateral CICADs.
Hepatic compartment syndrome (HCS) is a rare complication of liver subcapsular hematoma leading to hepatic ischemia. Early decompression of hematoma is recommended to reduce the risk of hepatic failure. We present two cases of HCS secondary to blunt trauma, which resolved spontaneously. A 19-year-old woman and a 52-year-old man presented with liver subcapsular hematoma. In both cases, marked deterioration of liver function was observed a few days after the trauma, and the reflux from the right portal vein, decrease in liver parenchymal density on CT, and high serum LDH value suggested hepatic circulatory disorder secondary to HCS. Transcatheter arterial embolization (TAE) was performed, and improvement of the liver function observed following intraperitoneal hemorrhage suggested spontaneous rupture of the subcapsular hematoma. TAE was effective in preventing rebleeding after the rupture. Our cases demonstrated the possibility of spontaneous resolution of HCS without hematoma drainage.
As the adrenal glands are enveloped in the Gerota fascia, which have packing effects, cases of traumatic adrenal injury are self-limiting. An 85-year-old man was suspected of having duodenal injury and right adrenal gland injury due to blunt trauma. Although preservative treatment was carried out, sudden right abdominal pain was observed on day 20 of hospitalization. He was diagnosed with delayed adrenal rupture by contrast-enhanced CT examination and emergency transcatheter embolization was performed. Although delayed rupture of the adrenal gland has not been previously reported and is rare, rapid diagnosis and hemostasis treatment are necessary.