Among 51 severe head injury patients, six cases of transverse sinus occlusion were diagnosed by CT-angiography. All patients had skull fractures, five of which were caused by traffic accidents and one by a fall. A young woman was diagnosed by MRI as having delayed venous infarction. Her hemiplegia recovered spontaneously. Asymptomatic hemi occlusion of transverse sinus may be overlooked in severe head injuries.
This report presents a case of persistent disturbance of consciousness due to hypoxemia caused by negative pressure in a ventilation duct. A 30-year-old male was found with his upper body trapped in a ventilation duct. He was rescued after the ventilator was turned off. After tracheal intubation, he underwent therapeutic hypothermia and sedation treatment for cerebral ischemia. His consciousness improved and tracheal extubation was performed on the third day. On the 12th day, he was transferred to the general ward for rehabilitation. Hypoxemia usually occurs as the result of accidents in water, chest compressions, toxic gases, or hypoxic environments ; however, there are no reports of hypoxemia caused by negative pressure in a ventilation duct. In the case reported here, a young healthy male adult was unable to escape from the duct and would have almost certainly died. Therefore, measures to prevent this type of accident are necessary.
A 2-year-old boy was run over by a car and admitted to our hospital. His injury was diagnosed as pelvic fracture with disruption of the pelvic ring. As he was found to be in a state of shock, we immediately performed transcatheter arterial embolization (TAE) under general anesthesia. Vital signs were stabilized and progression of anemia was corrected by TAE. TAE or surgery for hemostasis in pediatric pelvic trauma cases is extremely rare. However, the effects of hemorrhage in children are considerably greater and more critical than those in adults. If there are symptoms of circulatory insufficiency, hemostasis treatment should be proactively performed.
The patient was an 11-year-old boy. He fell and was hit in the epigastrium by the stainless-steel canteen hanging from his neck. He developed epigastric pain and vomiting. At the hospital, he exhibited severe pressure pain and rebound tenderness in the epigastrium. Contrast-enhanced computed tomography revealed a high-density area in the descending portion of the duodenum and tears in the pancreatic head surrounded by fluid. He was diagnosed with traumatic intramural hematoma of the duodenum complicated by pancreatic injury. Laparotomy was performed because of marked peritoneal irritation and suspected pancreatic injury. The intramural hematoma of the duodenum was removed. He had a favorable postoperative course and was discharged on the 13th hospital day. If treatment is expected to be prolonged for traumatic intramural hematoma of the duodenum accompanied by severe abdominal symptoms or suspected concomitant injury of other organs, surgical treatment should be considered.
Vulval hematomas are mainly observed in obstetrics, but they may occur after sexual intercourse. A 40-year-old woman developed pain and swelling in her right vulval region during sexual intercourse. She presented to the emergency department because the pain had worsened. We observed a right vulval hematoma on contrast-enhanced computed tomography, with extravasation of contrast medium into the hematoma. After transcatheter arterial embolization, the hematoma was removed. The patient was discharged 5 days later. A growing hematoma displaces structures, including blood vessels, which can change the anatomical layout. Ligation of the artery may become difficult in such cases, but arterial embolization is useful. Arterial embolization should be selected as the first-line treatment for a vulval hematoma that develops after sexual intercourse or during the postpartum period.
A 40-year-old man who had hit his back against a large tree was brought to the hospital by helicopter and admitted. Computed tomography imaging demonstrated fracture of the 10th thoracic vertebra, hemothorax, multiple rib fractures, and liver injury. On day 11, pleural effusion increased and we drained 1500 mL of fluid from the chylothorax. We started conservative management with a non-oral feeding regimen, but the volume of the chyle leak did not decrease. On day 30, thoracic duct embolization was attempted, but was unsuccessful. Thoracotomy for thoracic duct ligation was performed on day 36. Postoperatively, the chyle leak decreased in volume. On day 63, the patient was transferred to a rehabilitation hospital. Traumatic chylothorax is very rare. If the volume of chyle leakage is high, early thoracic duct ligation may be required. To identify the injury site, lymphangiography and lymphatic scintigraphy are useful.