[Purpose] This study aimed to determine the characteristics of internal organ injuries in the abdomen and pelvis. [Subjects/Methods] The analysis included 27,877 patients who were registered in the Japan Trauma Data Bank between 2004 and 2019. All patients had abdominal and pelvic internal organ injuries with an abbreviated injury scale (AIS) severity score of ≥ 2. The number of patients, mechanism of injury, prognoses, and concurrent injuries are described. [Results] The majority of the cases involved parenchymal organ injuries due to blunt trauma such as vehicle crashes and falls. The proportion of younger patients was higher for parenchymal organ injuries than luminal organ injuries. The proportion of penetrating injuries was higher in luminal organ injuries than in parenchymal organ injuries. More than 100 cases involved major organ injuries. Patients with colon and rectal injuries had the highest in-hospital mortality rate, and patients with bladder injuries had the lowest in-hospital mortality rate. Concurrent injuries were observed in the neighboring body regions or organs. [Conclusion] This study documented specific characteristics and anatomical features of internal organ injuries in the abdomen and pelvis, which may provide useful cues for diagnosis and treatment planning.

　　A 61-year-old woman who had been injured in a traffic accident was taken to the nearest hospital, then transferred to our hospital two hours later. Contrast-enhanced CT (CE-CT) revealed an injury to the right ventral side of the isthmus of the horseshoe kidney with extravasation. We performed transcatheter arterial embolization (TAE). On hospital day 25, a urinary excretory phase CE-CT examination revealed a urinoma and perinephric abscess. We performed percutaneous drainage for the abscess and inserted a double J ureteral catheter. However, as the urinary extravasation persisted, we performed a partial renal ablation using TAE on day 41. The patient was transferred to the Urology Department, and she was discharged on day 151 after undergoing nephrostomy. Intervention radiology is an effective therapy that can preserve the kidney in cases of refractory urinary extravasation with perinephric abscess.

　　Damage control surgery is generally the treatment strategy of choice for patients at high risk of coagulopathy and hypothermia due to severe liver injury (SLI) and massive hemoperitoneum (MH). In this context, abbreviated surgery is frequently employed as the primary surgical procedure for patients with comorbid injuries. We report a case of SLI and renal artery injury (RAI) that was successfully treated with primary definitive repair. The patient, an 18 y.o. male, was injured in a traffic accident. CE-CT revealed SLI with MH and RAI. He underwent urgent laparotomy. First the hemodynamics were stabilized by massive transfusion and bleeding control. Then, we completed right hepatectomy and reconstruction of the artery. Even in cases of abdominal injury with MH, precise diagnosis and identification of the source of bleeding are important, as they warrant early hemodynamic stabilization and allow the prolonged operative time necessary for primary definite repair.

　　Traumatic abdominal aortic injury is rare and has a high mortality rate, which makes its prompt diagnosis and treatment crucial. Patients presenting with bleeding are managed surgically, whereas those with stable vital signs are managed conservatively. Our hospital has a hybrid emergency room (ER), equipped with a computed tomography (CT) scanner, fluoroscope, and an operating theater allowing for emergent resuscitation, diagnosis, and treatment of patients in one location. We present a case of a man in his 70s who was admitted to our hybrid ER. He was in shock after a road-traffic accident. CT revealed an abdominal aortic injury with extravasation. We performed resuscitative endovascular balloon occlusion of the aorta from the femoral artery to Zone 3. Subsequently, coiling and stent grafts from bilateral femoral arteries were placed to stop bleeding and save the patient. This report highlights the usefulness of a hybrid ER system in managing a patient with traumatic abdominal aortic injury.

　　A 35-year-old man was admitted with a left temporal contusion, head and neck wounds, and hemorrhagic shock. The left external jugular vein and left superficial temporal artery were ligated promptly. Craniotomy was then performed to evacuate the acute epidural hematoma (AEDH) after the resolution of hemorrhagic shock. Arteriovenous fistula (AVF) was suspected on preoperative computed tomography. Selective cerebral angiography on day 2 revealed two AVFs : (1) from the left middle meningeal artery to the superficial middle cerebral and superior ophthalmic veins (middle meningeal arteriovenous fistula, MMAF), and (2) from a branch of the internal carotid artery to the cavernous sinus (carotid-cavernous sinus fistula, CCSF). On day 4, MMAF was treated with coil embolization, and CCSF was treated conservatively because of low risk of bleeding. Appropriate treatment of the head and neck wounds and AEDH, and the prompt diagnosis and treatment of the AVFs resulted in good patient outcomes.

　　Indocyanine green (ICG) fluorescence imaging is being increasingly used to evaluate intestinal blood flow during colorectal surgery. However, few studies have evaluated this procedure for trauma assessment. We report our experience of treating a patient with gastrointestinal injury due to blunt trauma, where the extent of bowel resection was determined using intraoperative ICG fluorescence imaging. A 37-year-old man who was injured after falling from a height of approximately 3 m was admitted to our hospital. Contrast-enhanced computed tomography revealed intra-abdominal hemorrhage and mesenteric injury ; therefore, emergency laparotomy was performed. As the patient’s hemodynamics were stable, one-stage intestinal anastomosis was performed. Intraoperative ICG-imaging was used to evaluate intestinal blood flow to assist in determining the colonic dissection line and avoid the risk of anastomotic leakage. The patient was discharged from the hospital without any complications. The results suggest that this evaluation method is useful for patients with trauma.