Journal of the Japanese Association for the Surgery of Trauma
Online ISSN : 2188-0190
Print ISSN : 1340-6264
ISSN-L : 1340-6264
Advance online publication
Displaying 1-15 of 15 articles from this issue
  • Shunsuke KURAMOTO, Tomohiro FUJITA, Kohei KUDO, Rui KAWAGUCHI, Tomohir ...
    Article type: Case Report
    Article ID: 38.3_14
    Published: 2024
    Advance online publication: June 26, 2024
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

      A 62-year-old man was admitted to the emergency room after being involved in a traffic accident and becoming trapped between two vehicles. He complained of tenderness in the mid-thoracic region, and computed tomography (CT) showed a sternal fracture and an anterior mediastinal hematoma. The following day, a blood test showed progression of anemia and CT revealed a hematoma extending from the anterior mediastinum into the right thoracic cavity, which had not been present at the initial examination. The patient was treated conservatively, without signs of deterioration, and was discharged on day 8. However, an X-ray taken on day 14 showed expansion of the hematoma. The patient underwent right thoracic drainage and was readmitted to the hospital. Drainage proved inadequate ; therefore, video-assisted thoracoscopic surgery for hematoma was performed on day 21. The patient was discharged on day 26. Although rare, hemothorax can occur late after a sternal fracture, and a treatment strategy should be developed with this in mind.

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  • Takamitsu MASUDA, Nodoka YAMAMORI, Shuhei MATSUYAMA, Kana UCHIDA, Mako ...
    Article type: Case Report
    Article ID: 38.3_15
    Published: 2024
    Advance online publication: June 26, 2024
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

      Case 1 was a 70-year-old man who had been injured in a hit-and-run accident. Computed tomography (CT) showed liver injury, pelvic fracture, and multiple rib fractures. Transcatheter arterial embolization (TAE) of the medial branch of the left hepatic artery and internal iliac arteries was performed for hemostasis. After TAE, the patient remained in shock, and CT revealed severe hemothorax. Repeat TAE involving the intercostal arteries achieved hemostasis. Case 2 was a 70-year-old man who fell from the second floor of a building. CT identified multiple vertebral and rib fractures as well as mild but worsening hemothorax. No extravasation was noted on contrast-enhanced CT, but digital subtraction angiography revealed extravasation from the 4th intercostal artery. TAE of this artery achieved hemostasis. In conclusion, unless the vital signs of patients are stable, TAE may a useful treatment for severe hemothorax.

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  • Mitsuyuki MIYAZATO, Halleluyah KONNO, Akane HORIUCHI, Norihiro WATANAB ...
    Article type: Case Report
    Article ID: 38.3_11
    Published: 2024
    Advance online publication: May 16, 2024
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

      A 79-year-old woman sustained injuries after being hit by a car while walking. Upon arrival of emergency medical services, a deformity of her right thoracic region and respiratory failure were observed. Trauma bypass via medical helicopter was considered ; however, she was transported to our hospital, the closest emergency facility, by ambulance, despite it not being a trauma center. On arrival, the patient presented with severe shock due to a flail chest, abdominal wall injury, and an unstable pelvic fracture. Following initial resuscitation, which included bilateral thoracic drain placement, tracheal intubation, external pelvic wound fixation, and retroperitoneal packing, the patient was transferred to a trauma center by helicopter with ongoing respiratory and circulatory support. The patient opted for initial treatment at a hospital with superior personnel, workspace, and medical equipment over helicopter transport. Through cooperation with the medical team, her life was saved.

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  • Kohei ANDO, Kenji FUJIWARA
    Article type: Others
    Article ID: 38.3_13
    Published: 2024
    Advance online publication: May 31, 2024
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      Although firearm-related injuries are rare in Japan, when such incidents occur, a prompt response in accordance with the current emergency medical system should be implemented and the patient should be provided with the best possible treatment at an appropriate medical institution. On the other hand, in a conflict situation, it is anticipated that numerous casualties occur simultaneously, complicating rescue efforts until safety and access routes are secured. Therefore, the choice of destination for transportation is likely to be influenced by the capacity and availability of medical and living resources at accessible medical facilities rather than the appropriateness of the medical care they can provide. As a result, logistical functions may become stagnant, and if the situation is prolonged, available medical supplies may become insufficient. This could require medical treatment to be conducted under traumatic and unfamiliar conditions. We have been associated with an organization specializing in surgical treatment under such circumstances. This paper reports our experience of on-the-ground treatment, management, and organizational procedures.

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  • Akira OHASHI, Hiroshi FUKUMA, Shota NAKAO
    Article type: Case Report
    Article ID: 38.3_12
    Published: 2024
    Advance online publication: May 24, 2024
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

      A 2-month-old girl was admitted to our hospital after her 2-year-old brother accidentally fell on her head. Initial neurological examination was normal, but a depression fracture was palpated in the right temporal region. Head computed tomography revealed a ping-pong fracture. We performed surgery. The patient had no postoperative complications and was discharged after 8 days. In infants, some depressed skull fractures are referred to as ‘ping-pong’ fractures due to the relative plasticity of the skull. While ping-pong fractures in infants often result from low-risk injury mechanisms, those occurring after infancy are typically associated with high-risk injury mechanisms, as defined by JATECTM, such as trauma caused by traffic accidents. Ping-pong fractures are conditions where spontaneous reduction is anticipated. Therefore, the decision for surgical intervention should be carefully considered on a case-by-case basis. In the present case, the patient had a rare non-high-risk injury and underwent early surgical treatment with a favorable outcome.

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  • Minnie CHAN, Makoto TAKAOKA
    Article type: Case Report
    Article ID: 38.3_09
    Published: 2024
    Advance online publication: May 01, 2024
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      A man in his 80s with a history of diabetes, hypertension, and angina pectoris was admitted to the hospital after he hit his face against a “fusuma” door and subsequently complained of back pain. Magnetic resonance imaging (MRI) revealed retropharyngeal hematoma with diffuse idiopathic skeletal hyperostosis (DISH) and anteriorly projecting C7-Th1 osteophytes. Several days later, the patient presented with septic shock secondary to mediastinitis. Esophagogastroduodenoscopy demonstrated an esophageal perforation adjacent to the osteophytes, which was treated conservatively. About one month later, the patient presented with sudden-onset sustained C7-Th1 spondylodiscitis, epidural abscess, and intramedullary spinal cord abscess, resulting in persistent paraplegia. DISH is typically asymptomatic ; however, esophageal injury by prominent osteophytes may occur with neck hyperextension, highlighting the possibility of complicating spinal infection in patients with mediastinitis. MRI is useful for early diagnosis and understanding the pathophysiology in such patients.

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  • Fuminori YAMAJI, Aya TANABE, Yuuya TOSAKA, Jyun KAWACHI, Hideshi OKADA ...
    Article type: Others
    Article ID: 38.3_10
    Published: 2024
    Advance online publication: April 23, 2024
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

      In Japan, training trauma surgeons with experience in managing gunshot wounds is important ; however, acquiring such expertise domestically is challenging. The Chris Hani Baragwanath Academic Hospital in South Africa handles a high volume of trauma cases including gunshot wounds and stabbings. The hospital has established an educational system led by consultants and regularly hosts trainees from around the world. Our team completed a 4-week observation and an 11-week trauma surgery training program at the hospital. During the training, the trauma unit managed 1,187 patients, including 516 stabbing and 236 gunshot cases, and performed 321 surgeries, including 168 emergency laparotomies and 21 thoracotomies. The program offered comprehensive training encompassing resuscitation room management, surgeries, and postoperative care, while integrating trainees into the team. South Africa exemplifies excellence in trauma training, underscoring the significance of ongoing international partnerships.

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  • Natsuki HASHIBA, Tomokazu MOTOMURA, Masataka SUGII, Tetsuya NISHIMOTO, ...
    Article type: Original Article
    Article ID: 38.3_05
    Published: 2024
    Advance online publication: April 17, 2024
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      Background : Motor vehicle accidents (MVAs) and deaths have been decreasing due to advances in motor vehicle technology and emergency medicine. However, despite serving as a crucial safety measure, seatbelt injuries are encountered in clinical practice.

      Methods : Nippon Medical School Chiba Hokusoh Hospital has been collecting data from patients and vehicles involved in MVAs since November 2009 in collaboration with Nihon University College of Engineering. This single-center retrospective study was conducted from November 2009 to May 2022. Inclusion criteria were patients injured in frontal collisions who consented to participate in the research. We sought to identify relationships between seatbelt use and abdominal solid/hollow organ injuries.

      Results : Of 4,086 patients involved in MVAs, 491 patients were enrolled. Mean age was 49.5 ± 21.9 years, mean equivalent barrier speed was 36.9 ± 14 km/h, median Injury Severity Score (ISS) was 9, ISS 16+ was 33%, and 81% wore seatbelts. Abdominal solid organ injuries were significantly more frequent in patients that did not wear seatbelts than those that wore seatbelts (30% vs. 11%, p < 0.01). On the other hand, there were significantly more hollow organ injuries in patients who wore seatbelts (21% vs. 4%, p = 0.01).

      Conclusion : Although seatbelts are important for safety, improvements are necessary.

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  • Keita MINOWA, Akihide KON, Shingo KONNO, Tatsuya NODAGASHIRA, Tomohisa ...
    Article type: Case Report
    Article ID: 38.3_06
    Published: 2024
    Advance online publication: April 17, 2024
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

      A man in his fifties slipped and fell in a parking lot, hitting his head. He was taking two antithrombotic medications. The patient visited our hospital for headache. Physical examination revealed tenderness in the occipital area. CT revealed acute subdural hematoma and cerebral contusion. After admission, the patient exhibited disorientation, followed by aphasia and paralysis. Subsequent CT scans revealed exacerbation of intracranial lesions, prompting us to perform craniotomy on day 3. We had intended to start anticoagulant therapy once we determined that the risk of postoperative hemorrhagic complications was low, but the patient developed pulmonary thromboembolism and went into cardiac arrest temporarily on day 15. We performed resuscitation and the patient survived. We initiated anticoagulant therapy with heparin. The patient recovered with the therapy and was transferred for rehabilitation on day 61. Anticoagulant therapy should be considered in the early postoperative period to prevent venous thromboembolism after head injury surgery.

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  • Keishi OKAMOTO, Yusuke KATAYAMA, Takeshi EBIHARA, Yurie ISHIMURA, Hisa ...
    Article type: Case Report
    Article ID: 38.3_07
    Published: 2024
    Advance online publication: April 17, 2024
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

      We report a case of a 41-year-old male who was injured in a traffic accident and transported to our hospital. Whole-body computed tomography (CT) revealed right pneumothorax, pneumopericardium, and intraperitoneal hemorrhage due to mesenteric injury. He developed hemorrhagic shock. Emergency laparotomy was performed to achieve hemostasis, and open abdomen management (OAM) was initiated. We determined that the pericardium and right pleural cavity were communicating ; therefore, right chest drainage was performed to treat his pneumopericardium and right pneumothorax. In the intensive care unit, the patient developed obstructive shock due to tension pneumopericardium. As OAM may have created communication between the pericardium and the intra-abdominal space, pericardium drainage was performed using an anterior parasternal approach rather than a subxiphoid approach. The patient recovered from his shock episode following the drainage procedure and was discharged home on day 52 following his admission to the hospital.

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  • Akitoshi ANDO, Tomohiro MURONOI, Shunsuke KURAMOTO, Kazuyuki OKA, Yosh ...
    Article type: Others
    Article ID: 38.3_08
    Published: 2024
    Advance online publication: April 17, 2024
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

      In recent years, the number of surgical trauma cases has decreased due to the reduction in traffic accidents and advances in non-operative management. Consequently, training trauma surgeons has become increasingly challenging. While simulation training with animals and donated bodies is conducted, accessibility remains limited due to the low number of events and participants. Although learning through surgical videos is widely used in the field of surgery and its usefulness has been reported, there are few surgical videos related to trauma surgery techniques. Enhancements in the training system for trauma surgery are necessary. We call on the Japanese Association for The Surgery of Trauma to create a database of online videos on trauma surgery. Consolidating surgical videos of trauma cases in a library and sharing techniques and strategies for the treatment of major trauma cases will be a useful reference for improving the skills of young surgeons. Although issues exist, such as consideration for patient privacy and increased workload due to video editing, trauma surgery education using surgical videos is a useful endeavor in the field of trauma.

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  • Shinsuke TANIZAKI, Ken-ichi KANO, Shigenobu MAEDA
    Article type: Case Report
    Article ID: 38.3_03
    Published: 2024
    Advance online publication: April 03, 2024
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

      An 85-year-old male was injured when his lower body was trapped under a rotary tiller of a tractor and crushed by the tilling claws while working in a field. He had an open wound of the left lower abdomen with evisceration, as well as open wounds in the left thigh and right lower leg. The center of the transverse colon and the distal part of the descending colon had both ruptured, and severe crushing of the left abdominal wall was observed. Left hemicolectomy, colostomy, and wound debridement were performed. The wound was managed using negative pressure wound therapy ; however, because the soft tissue for reconstruction was also severely damaged, we closed the ruptured abdominal wall wound on the left side using a flap reconstruction procedure from the left chest.

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  • Yoshitaka OOYA, Shuhei MIYATA, Masahito KAJI
    Article type: Case Report
    Article ID: 38.3_04
    Published: 2024
    Advance online publication: April 03, 2024
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

      A 50-year-old male with multiple gunshot injuries underwent multiple surgeries on the day of admission, including surgery for spinal cord injury. After being shot in front of his home, he was brought to our hospital for emergency treatment. Contrast-enhanced computed tomography of his neck and lower extremities revealed right hemothorax and liver and spinal cord injury. After emergency laparotomy and transcatheter arterial embolization for the liver injury, the patient’s general condition stabilized in the intensive care unit, and he underwent spinal surgery on the same day. After postoperative rehabilitation, the patient was able to walk independently and was discharged for home. The approach for managing gunshot injuries involves stabilizing respiration and circulation with reliable hemostasis, followed by treatment to reduce functional impairment as early as feasible.

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  • Teppei TOKUMARU, Hideaki KURATA, Shoko OKAMURA, Joji TOMIOKA
    Article type: Case Report
    Article ID: 38.3_02
    Published: 2024
    Advance online publication: March 15, 2024
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

      Treatment strategies for life-threatening liver injuries remain controversial and challenging. A man in his 50s, with a history of heavy drinking, suffered a blunt thoracoabdominal injury in a single motor vehicle crash. Transarterial embolization was performed for the posterior branch of the right hepatic artery because of an intraparenchymal hematoma with active arterial bleeding. After eight hours, perihepatic packing was conducted due to rebleeding. Six hours later, open abdomen management was administered for abdominal compartment syndrome. Forty hours later, a planned reoperation was performed, which included resectional debridement for liver injury and transcystic C-tube drainage. Drain management for liver infarction and infection was performed as a bridging treatment, and the patient was subsequently discharged in a favorable condition. It is suggested that continuous assessment and modification of the damage control strategy for severe liver injury helps achieve favorable outcomes.

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  • Ryuichiro OKUDA, Yasuaki YAMAKAWA, Tadashi KOMATSUBARA, Toshiyuki MATS ...
    Article type: Clinical Experience
    Article ID: 38.3_01
    Published: 2024
    Advance online publication: March 01, 2024
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

    Objective

    To investigate the effectiveness and problems of prehospital tourniquet use in our hospital.

    Methods

    Thos was a single-center retrospective study. Subjects were trauma patients with an Injury Severity Score (ISS) of 9 or higher who were transported to our hospital between 2019 and 2022.

    Results

    A total of 853 trauma patients were included in this study. There were 194 upper- and 459 lower-extremity trauma cases. Five patients had a tourniquet applied, their median age was 57 years (range, 43 - 83 years), all were male, and they involved two upper- and three lower-extremity trauma cases. One of the five cases had arterial injury (peroneal artery injury). Complications caused by tourniquet use included deep vein thrombosis in one patient and insufficient pressure that contributed to venous hemorrhage in another patient.

    Conclusion

    While tourniquet use was effective, there were some associated complications. The duration of tourniquet use exceeded two hours in some cases, and this is an issue that needs to be improved.

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