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Typical Computed Tomographic Images and Operation for Grade IV Pancreatic Injury 四级胰腺损伤的典型ct影像与手术
Trauma Image and Procedure Pub Date : 2019-05-31 DOI: 10.24184/tip.2019.4.1.3
C. Park, Wu-Seong Kang
{"title":"Typical Computed Tomographic Images and Operation for Grade IV Pancreatic Injury","authors":"C. Park, Wu-Seong Kang","doi":"10.24184/tip.2019.4.1.3","DOIUrl":"https://doi.org/10.24184/tip.2019.4.1.3","url":null,"abstract":"A 43-year-old woman who had been in a traffic accident was referred to our emergency department from another hospital after a driver traffic accident. Her initial vital signs were unstable: blood pressure, 75/58 mm Hg; pulse rate, 95 beats/min; respiration rate, 18 breaths/min; body temperature, 36.8°C; and oxygen saturation, 98%. Abdominal computed tomography (CT) performed at another hospital revealed complete transection of the pancreas to the right of the superior mesenteric vein (Fig. 1.). Injury severity score of the patient was 57. Emergency surgery was performed, and pancreatic transection was observed (Fig. 2.). The splenic artery and vein were ligated at their proximal portions (Fig. 3.), and subtotal pancreatectomy was performed (Fig. 4.). After ligation of the main pancreatic duct in the remnant pancreas, the pancreatic stump was closed by fish-mouth interrupted sutures. The initial serum amylase and lipase levels were 104 and 275 IU/L, respectively, and their levels were highest (797 and 671 IU/L, respectively) on day 3 (Fig. 5.). A pancreatic pseudocyst was developed during follow-up period and succesfully treated by percutaneous drainage.","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"360 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122769298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Unexpected Delayed Rupture of the Spleen That Initially Appeared Normal on Computed Tomography 最初在计算机断层扫描上显示正常的脾脏意外延迟破裂
Trauma Image and Procedure Pub Date : 2019-05-31 DOI: 10.24184/tip.2019.4.1.19
J. S. Chung, Jongeun Choi, P. Y. Jung
{"title":"Unexpected Delayed Rupture of the Spleen That Initially Appeared Normal on Computed Tomography","authors":"J. S. Chung, Jongeun Choi, P. Y. Jung","doi":"10.24184/tip.2019.4.1.19","DOIUrl":"https://doi.org/10.24184/tip.2019.4.1.19","url":null,"abstract":"A 47-year-old man had been a passenger in a traffic accident, and he was found outside the car when he was rescued. On arrival to our trauma center, although he was intoxicated, he had a Glasgow Coma Scale score of 15, was neurologically intact, and complained only of a headache. In the emergency room, computed tomographic (CT) scans of the brain, neck, chest (with contrast material), and abdomen and pelvis (with contrast material) were obtained. Imaging findings included an acute subdural hemorrhage with scalp laceration. No other acute findings were seen on the initial abdomenpelvis contrast-enhanced image. The official reading of the CT scan by the radiologist was also normal (Fig. 1.). The patient was admitted to general ward for nonoperative management. Four days after hospitalization, the patient’s hemoglobin level dropped abruptly from 17.0 to 9.9 g/dL. A second abdomen-pelvis CT scan with contrast material revealed a grade IV splenic rupture with hemoperitoneum (Fig. 2.). The patient was taken to the operating room for emergency explorative laparotomy, and splenectomy was performed (Fig. 3.). Eleven days after admission, the patient was discharged home.","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"127 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133537788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Surgical Fixation of the Coronal Separated Sternal Fracture in the Anterior Flail Chest using ZipFixTM and SternaLock Plating System 应用ZipFixTM和SternaLock电镀系统固定前连枷胸冠状分离性胸骨骨折
Trauma Image and Procedure Pub Date : 2018-11-30 DOI: 10.24184/TIP.2018.3.2.68
D. Ma, K. Choi, Sung Jin Kim, Seokwon Joo, S. Hyun, Y. Jeon
{"title":"Surgical Fixation of the Coronal Separated Sternal Fracture in the Anterior Flail Chest using ZipFixTM and SternaLock Plating System","authors":"D. Ma, K. Choi, Sung Jin Kim, Seokwon Joo, S. Hyun, Y. Jeon","doi":"10.24184/TIP.2018.3.2.68","DOIUrl":"https://doi.org/10.24184/TIP.2018.3.2.68","url":null,"abstract":"A 57-year-old male injured in a pedestrian traffic accident was transferred to our Regional Trauma Center. Immediate intubation was performed due to stupor mentality and respiratory distress at presentation. After resuscitation and physical examination, he was transferred to Trauma Intensive Care Unit. The chest computed tomography (CT) revealed multiple rib fractures at the bilateral anterior arch from 3rd to 6th ribs and comminuted fracture of the sternum (Fig. 1). He was diagnosed with anterior flail chest with concomitant injuries, i.e., fracture of the pedicle right at the 4th cervical spine, complex pelvic fracture including the right iliac wing, superior and inferior ramus of the bilateral pubis, sacrum ala, and intertrochanteric part of the right femur. On day 4 of hospitalization, rib CT was performed to evaluate sternum and rib fractures (Fig. 2). Five days later, surgical treatment was decided for the sternal fracture because weaning was still difficult despite reduced ventilator support and clear recovery of mental status. After a midline longitudinal incision between the 3rd and 5th costal notch, meticulous dissection was performed to expose healthy bones and 4th intercostal space. The DeBakey peripheral vascular clamp was used to carefully pass below the posterior segment, and then the Penrose tube was pulled and placed bilaterally (Fig. 3-1). Zipfix (Synthes GmbH, Oberdorf, Switzerland) was placed after the cutting needle passed through the Penrose tube. Hematoma removal was sequentially performed between the fragment and approximation, and then the Zipfix was tightened (Fig. 3-2). The 8-hole X plate of the SternaLock Blu (Biomet Microfixation Inc., Jacksonville, FL, USA) was used to transverse the fracture site (Fig.3-3). On postoperative day 2, the patient was How to Do It in Trauma eISSN: 2508-8033 pISSN: 2508-5298","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124951713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Two Cases of Near-Missed Intestinal Perforation at the Initial Survey of Trauma Patients 创伤患者初步调查肠穿孔近漏诊2例
Trauma Image and Procedure Pub Date : 2018-11-30 DOI: 10.24184/TIP.2018.3.2.53
Joongsuck Kim, O. Kwon, Kyounghwan Kim, Min Koo Lee, Ho Hyoung Lee, Sung Ho Han, S. Yang
{"title":"Two Cases of Near-Missed Intestinal Perforation at the Initial Survey of Trauma Patients","authors":"Joongsuck Kim, O. Kwon, Kyounghwan Kim, Min Koo Lee, Ho Hyoung Lee, Sung Ho Han, S. Yang","doi":"10.24184/TIP.2018.3.2.53","DOIUrl":"https://doi.org/10.24184/TIP.2018.3.2.53","url":null,"abstract":"Untreated intestinal perforation sustained following a blunt trauma mostly results in generalized peritonitis, ultimately leading to sepsis. Most cases warrant surgical repair. Thus, any signs and symptoms of intestinal perforation should be crucially detected, and a general surgeon should be immediately consulted. These signs include abdominal tenderness, abdominal distention, fever, and leukocytosis. With the advent of computed tomography (CT) scans, the detection rate of perforation improved. However, the signs and scans remain non-definitive in some cases. Here, we present two cases of near-missed intestinal perforation: one case was clearly suspected of intestinal perforation, whereas the other was not so apparent. First case A 55-year-old male presented to the emergency room (ER) after sustaining a fall from an approximately 3-m-high site with complaints of severe abdominal pain. His vital signs were stable. The CT scan revealed an apparent small pneumoperitoneum (Fig. 1). The patient was immediately brought to the operating room (OR) for exploratory laparotomy, which revealed a 2-cm-sized laceration at the antimesenteric border of the proximal jejunum. Minimal bowel content spillage was noted and there were no other internal organ injuries. The laceration was primarily repaired. The patient was discharged on postoperative day 10 without complication.","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128285104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Renorrhaphy Using Pledgeted Sutures for Grade IV Renal Trauma IV级肾外伤采用有质缝合线进行再缝合
Trauma Image and Procedure Pub Date : 2018-11-30 DOI: 10.24184/TIP.2018.3.2.65
D. H. Kim
{"title":"Renorrhaphy Using Pledgeted Sutures for Grade IV Renal Trauma","authors":"D. H. Kim","doi":"10.24184/TIP.2018.3.2.65","DOIUrl":"https://doi.org/10.24184/TIP.2018.3.2.65","url":null,"abstract":"The wire under construction hit the right back of a 56-year-old male (Fig. 1). Upon admission, the patient’s blood pressure was 92/59 mm Hg, pulse rate was 125 beats/min, and he had been transfused with 2 units of packed red blood cell. The focused assessment with sonography for trauma revealed intra-abdominal fluid collection in the Morison pouch. Abdomen computed tomography (CT) performed in response to resuscitation demonstrated multiple laceration at the Couinaud segment V, VI, and VII of the liver, and multiple lacerations deep to the calyx in the right kidney with the contrast extravasation (Fig. 2). The injury severity score was 26. Therefore, he underwent emergency laparotomy due to intermittent hypotension. Right renorrhaphy with temporary renal vascular pedicle clamping after the temporary perihepatic packing was performed with transfusion of 2 units of packed red blood cell during How to Do It in Trauma eISSN: 2508-8033 pISSN: 2508-5298","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125831402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
A Penetrating Lung Injury by a Feeding Tube 由喂食管引起的穿透性肺损伤
Trauma Image and Procedure Pub Date : 2018-11-30 DOI: 10.24184/TIP.2018.3.2.50
Seok Won Lee, D. H. Kim, Ye Rim Chang, Jeongseok Yun, S. Choi, S. Chang, Jung-Ho Yun
{"title":"A Penetrating Lung Injury by a Feeding Tube","authors":"Seok Won Lee, D. H. Kim, Ye Rim Chang, Jeongseok Yun, S. Choi, S. Chang, Jung-Ho Yun","doi":"10.24184/TIP.2018.3.2.50","DOIUrl":"https://doi.org/10.24184/TIP.2018.3.2.50","url":null,"abstract":"","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"188 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126075291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Obstructive Atelectasis Caused by Total Obstruction of the Left Main Bronchus by Mucous Plug 粘液塞导致左主支气管完全阻塞的梗阻性肺不张
Trauma Image and Procedure Pub Date : 2018-11-30 DOI: 10.24184/TIP.2018.3.2.56
C. Park, Wu-Seong Kang
{"title":"Obstructive Atelectasis Caused by Total Obstruction of the Left Main Bronchus by Mucous Plug","authors":"C. Park, Wu-Seong Kang","doi":"10.24184/TIP.2018.3.2.56","DOIUrl":"https://doi.org/10.24184/TIP.2018.3.2.56","url":null,"abstract":"A 66-year-old male presented to the emergency department after suffering a major trauma. Endotracheal intubation and ventilator care were initiated on day 6 after hospitalization due to severe dyspnea. Open tracheostomy was performed on the 14th day of intubation. On the 20th day of tracheostomy, no atelectasis was observed in the AP chest radiography (Fig. 1A) and ABGA revealed the pH of 7.37, pCO2 of 36, pO2 of 121, HCO3 of 20.8, and O2 sat of 98.1. However, the total atelectasis in the left lung was observed in the AP chest radiography performed on the following day (Fig. 1B) and ABGA deteriorated to pH of 7.30, pCO2 of 42, pO2 of 54, HCO3 of 20.7, and O2 sat of 86.9. Fiberoptic bronchoscopy was performed to flush a very large amount of thick purulent secretion that totally obstructed the left main bronchus (Fig. 2). Atelectasis disappeared in the follow-up AP chest radiography (Fig. 3) and ABGA improved to pH of 7.32, pCO2 of 42, pO2 of 113, HCO3 of 21.6, and O2 sat of 99.2.","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134150159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hepatic Hemangioma Mistaken As Intraparenchymal Hematoma of the Spleen 肝血管瘤误诊为脾实质内血肿
Trauma Image and Procedure Pub Date : 2018-11-30 DOI: 10.24184/TIP.2018.3.2.47
J. Ye, S. J. Go, Y. Sul, Jin Young Lee, Jin Suk Lee, S. Yoon, Hong Rye Kim, Mou-Seop Lee, J. Choi
{"title":"Hepatic Hemangioma Mistaken As Intraparenchymal Hematoma of the Spleen","authors":"J. Ye, S. J. Go, Y. Sul, Jin Young Lee, Jin Suk Lee, S. Yoon, Hong Rye Kim, Mou-Seop Lee, J. Choi","doi":"10.24184/TIP.2018.3.2.47","DOIUrl":"https://doi.org/10.24184/TIP.2018.3.2.47","url":null,"abstract":"A 50-year-old male presented to the emergency department after meeting with a driver’s traffic accident. His mental status was alert, with all vital signs within normal ranges. The patient only complained of pain in the left lower chest wall. The findings of the focused assessment for sonography in trauma were all negative, and chest X-ray did not reveal any thoracic injuries. An abdominal computed tomography (CT) scan was subsequently performed, and it revealed an intraparenchymal hematoma in the spleen (Fig. 1). The patient was hospitalized and closely monitored. The organ perceived to be the spleen was then found to be hepatic tissue extended from the left liver. In addition, the intraparenchymal hematoma was mistaken as hemangioma (Fig. 2). In conclusion, hepatic hemangioma was mistaken as intraparenchymal hematoma in the spleen because of its position and shape. An atrophied spleen was observed between the tissue of hepatic hemangiomas, but the exact underlying cause is unknown (Fig. 2). The patient recovered with pain management and was discharged a few days later.","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124542417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Abdominal Wall Repair Using Two Continuous Acellular Porcine Dermal Collagen (PermacolTM) in a Patient with Large Retroperitoneal Hematoma and Bowel Edema 两种连续脱细胞猪真皮胶原蛋白(PermacolTM)用于腹膜后血肿和肠水肿患者的腹壁修复
Trauma Image and Procedure Pub Date : 2018-11-30 DOI: 10.24184/TIP.2018.3.2.58
C. Park
{"title":"Abdominal Wall Repair Using Two Continuous Acellular Porcine Dermal Collagen (PermacolTM) in a Patient with Large Retroperitoneal Hematoma and Bowel Edema","authors":"C. Park","doi":"10.24184/TIP.2018.3.2.58","DOIUrl":"https://doi.org/10.24184/TIP.2018.3.2.58","url":null,"abstract":"A 17-year-old male was referred to our emergency department from another hospital. He was struck by a dump truck while riding a bicycle. His initial vital signs were unstable: blood pressure, 90/50 mmHg; pulse rate, 122 beats/min; respiration rate, 27 breaths/min; body temperature, 34.9°C; and oxygen saturation, 99%. The pelvis was severely deformed by vertical shear (Fig. 1). Ligation of the left internal iliac artery and seromuscular repair of the sigmoid colon was performed in the emergency room. A large retroperitoneal hematoma and severe bowel edema were observed, and temporary abdominal closure was performed (Fig. 2). In addition, external fixation was performed on unstable pelvic fracture. The anal muscle was completely destroyed and the urethra could be directly touched by a finger. Post surgery, the patient was immediately moved to the interventional radiology room, where angioembolization Treatment Progression in Trauma eISSN: 2508-8033 pISSN: 2508-5298","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"95 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126440519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Simple and Safe Foley Catheter-Guided Tracheostomy Tube Changes 简单安全的Foley导管引导气管造口换管
Trauma Image and Procedure Pub Date : 2018-11-30 DOI: 10.24184/TIP.2018.3.2.72
C. Park, Wu-Seong Kang
{"title":"Simple and Safe Foley Catheter-Guided Tracheostomy Tube Changes","authors":"C. Park, Wu-Seong Kang","doi":"10.24184/TIP.2018.3.2.72","DOIUrl":"https://doi.org/10.24184/TIP.2018.3.2.72","url":null,"abstract":"","PeriodicalId":224399,"journal":{"name":"Trauma Image and Procedure","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133927223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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