We report a case of hemorrhagic shock secondary to injury to the highest intercostal artery caused by severe blunt chest trauma, which was successfully treated using damage-control surgery and interventional radiology (DC-IR). A 64-year-old woman who underwent pulmonary resection and definitive thoracotomy developed recurrent hemorrhagic shock 2 hours postoperatively. Contrast-enhanced computed tomography revealed a new injury to the highest intercostal artery and a massive hemothorax, both of which may contribute to progressive coagulopathy. Using DC-IR, we performed rapid re-thoracotomy and compression hemostasis concurrently with highest intercostal artery embolization. After embolization, the patient was transferred to the intensive care unit with gauze packing and temporary thoracic closure to manage intercostal artery backflow. Blunt injuries of the highest intercostal artery are rare. The combined use of DC-IR and gauze packing was effective due to the anatomical characteristics of the injury and the presence of associated coagulopathy. This report highlights the potential efficacy of intraoperative interventional radiology combined with gauze packing for rapid and effective hemostasis and management of blunt highest intercostal artery injuries accompanied by hemorrhagic shock.

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　　We encountered a case of traumatic rectal perforation following an abdominal contusion, with symptoms presenting four days later. A 70-year-old male fell and sustained lower abdominal bruising, with associated pain that subsided quickly. Four days after the injury, he developed lower abdominal pain and was hospitalized. CT revealed intra-abdominal free air, and the patient underwent emergency surgery. A perforation was observed in the sigmoid colon, which was treated by high anterior resection. The transmural perforation caused by the bruising was sealed by adhesions from the surrounding small intestine, leading to a delayed onset of symptoms. In gastrointestinal perforation cases due to blunt trauma, delayed perforations are occasionally reported, leading to symptoms being delayed following injury. To the best of our knowledge, this is the first report of this pathological condition.

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