Background : In elderly patients with an isolated abdominal injury, despite stable vital signs, some patients experience a minor disturbance of consciousness (DOC) due to delirium and a transient, relatively-decreased cerebral blood flow. Our study aimed to elucidate the association between the occurrence of minor DOC and in-hospital mortality. Methods : Using data from the Japan Trauma Data Bank, patients (> 65 years) registered as having isolated abdominal injuries between 2004 and 2017 were enrolled in the study. Exclusion criteria were as follows : 1) penetrating injuries, 2) systemic blood pressure < 90 mmHg on arrival, 3) JCS > 2, 4) alcohol consumption, 5) history of psychological illness or dementia, and 6) injury severity score (ISS) < 9. In-hospital mortality as a primary outcome was compared between the groups with and without minor DOC. Results : Among 54 cases of minor DOC and 212 cases of awake and alert (JCS 0), we recorded 12 and 14 in-hospital mortality cases, respectively. Multivariate analysis, performed using in-hospital mortality as the outcome, showed that minor DOC cases had an odds ratio of 3.26. Conclusion : In elderly patients with isolated abdominal injuries, minor DOC upon arrival is associated with in-hospital mortality.
A 74-year-old woman sustained abdominal blunt trauma in a traffic accident. Contrast-enhanced computed tomography (CT) revealed deep injury at the left-side isthmus of a horseshoe kidney. She underwent emergency transcatheter arterial embolization. The horseshoe kidney had an isthmus in the anterior part of the vertebral body, and thus had poor mobility. It was likely damaged by an external force from the front of the trunk. As horseshoe kidneys often have excessive renal arteries, examining preoperative CT angiography enables rapid detection of the bleeding site, leading to a faster and safer procedure.
A 15-year-old male was injured by jumping from a 2-m-high roof. X-ray and CT demonstrated right ankle pilon fracture. We performed emergency external fixation, but were unable to achieve a reducted position. After 3 days, we performed osteosynthesis of the fibula and posterior malleolar via the postero-lateral approach, and reducted the entrapped flexor digitorum longus tendon. After 16 days, we performed osteosynthesis of the anterior wall and medial malleolar and articular surfaces via the anterior approach. We then noted posterior tibialis tendon interposition in the syndesmosis and ankle joint. We reducted the tendon by partial removal of the posterior malleolar fixation. There have been 6 case reports of irreducible ankle dislocation fracture by posterior tibialis tendon interposition to the syndesmosis. In this case, the mechanism of interposition to the syndesmosis may have been similar to that in the previous 6 reports, but there has been no report of pilon fracture with posterior tibialis tendon interposition to the syndesmosis. In irreducible cases, diagnosis by CT is important.
We report a successful case of pancreaticoduodenectomy (PD) after damage-control surgery (DCS) for an abdominal stab wound. A 44-year-old man who stabbed himself in the left upper abdomen with a 20-cm-long kitchen knife was transported to our hospital. He had a Glasgow Coma Scale (GCS) of E3 V4 M5, blood pressure of 60/40 mmHg, and heart rate of 143 beats/min, and underwent emergency surgery. The knife had penetrated through his stomach, duodenum, and transverse mesocolon, and reached the hilum of the right kidney, with pulsatile bleeding. As his vital signs suggested shock, emergency DCS was needed, which included nephrectomy, closure of the gastrointestinal tract, towel packing, and towel clip closure. The following day, PD was performed for the complex duodenal injury. The patient was discharged after 40 postoperative days.
A 29-year-old Vietnamese man presented to a local clinic with a stab wound on the lateral aspect of his left thigh. Contrast-enhanced computed tomography (CT) revealed no arterial injury. Thus, the wound was sutured and he was discharged on day 4 of hospitalization. The day after discharge, while on board an airplane to Vietnam, he developed sudden swelling of the left thigh with pain and was examined at the previous clinic after an emergency landing. Contrast-enhanced CT revealed a ruptured left deep femoral artery pseudoaneurysm, and he was transported to this center. After arrival, coil embolization was performed twice ; however, the pseudoaneurysm persisted, necessitating surgical resection. He recovered uneventfully and was discharged on day 29 of hospitalization, and returned to Vietnam by airplane the day following discharge. Imaging studies are warranted to exclude pseudoaneurysms in patients boarding an aircraft in the early stages after penetrating trauma.
Severe non-obstetric genital hematomas are rare. We report a case of giant vulvar hematoma due to a bicycle accident. A female in her 20s fell while riding a bicycle and hit her genitals on the handle bars. After the injury, her vulvar hematoma increased in size and she was unable to move because of pain. Three hours after injury, she came to our hospital by ambulance. At the first visit, the right side of her vulva was swollen. CT demonstrated active bleeding. We performed TAE for hemostasis, and a small incision was then made inside her labia minora to remove the hematoma. Hematoma must be removed if the area is markedly large and/or there is severe pain. As hemostasis is necessary at the time of surgery, we performed TAE beforehand and were able to remove the hematoma through a minimally invasive incision.