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외상성 경부 척수 손상 환자에서 동반된 소장 천공: 증례보고
고승제 ( Seung Je Go ),윤정석 ( Jeung Seuk Yoon ),윤정호 ( Jung Ho Yun ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.4
A 66 year-old woman had cervical spinal cord injury by an automobile. We performed emergency operation for partial quadriplegia. She recovered from motor weakness gradually, but complained of abdominal distension and mild dyspnea. A physical examination of her abdomen did not have tenderness and rebound tenderness. She underwent a decubitus view of chest X-ray due to aggravated dyspnea at postoperative 4 days. We detected free air gas of abdomen and immediately identified a cause of pneumoperitoneum by abdominal computed tomography. We performed an emergent laparotomy and confirmed a jejunal perforation. After an operation, she recovered well and is under rehabilitation.
김중석 ( Joong Suck Kim ),고승제 ( Seung Je Go ),김지대 ( Ji Dae Kim ),설영훈 ( Young Hoon Sul ),예진봉 ( Jin Bong Ye ),박상순 ( Sang Soon Park ),구관우 ( Gwan Woo Ku ),김영철 ( Yeong Cheol Kim ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.4
An arteriovenous fistula (AVF) from the renal artery following a penetrating abdominal trauma is not common. We report the case of a 19-year-old male who presented with a knife stab wound in the right upper quadrant. Due to unstable vital signs and to the protrusion of the mesentery through the stab wound, providing definite evidence of peritoneal violation, an emergent exploratory laparotomy was carried out. There were injuries at the proximal transverse mesocolon and the second portion of the duodenum, with bile leakage. There was also a mild amount of retroperitoneal hematoma near the right kidney, without signs of expansion or pulsation. The mesocolon and the duodenum were repaired. After the operation, abdominal computerized tomography (CT) was performed, which revealed contrast from the right renal artery shunting directly into the vena cava. Transcatheter arterial embolization with a coil and vascular plug was performed, and the fistula was repaired. The patient recovered completely and was discharged without complication. For further and thorough evaluation of an abdominal trauma, especially one involving the retroperitoneum, a CT scan is recommended, when possible, either prior to surgery or after surgery when the patient is stabile. Furthermore, a lateral retroperitoneal hematoma and an AVF after a penetrating trauma may not always require exploration. Sometimes, it may be safely treated non-operatively or with embolization. [ J Trauma Inj 2015; 28: 262-265 ]
둔상성 외상 후 양측 간내 담관에서 담즙 누출의 치료 사례 1례
김동훈 ( Dong Hun Kim ),최석호 ( Seokho Choi ),고승제 ( Seung Je Go ) 대한외상학회 2014 大韓外傷學會誌 Vol.27 No.3
Bile leaks are complications that are much more frequent after a high-grade liver injury than after a low grade liver injury. In this report, we describe the management of bile leaks that were encountered after angiographic embolization in a 27-year-old man with a high-grade blunt liver injury. He had undergone an abdominal irrigation and drainage with a laparotomy on post-injury day (PID) 16 due to bile peritonitis and continuous bile leaks from percutaneous abdominal drainage. He required three percutaneous drainage procedures for a biloma and liver abscesses in hepatic segments 4, 5 and 8, as well as endoscopic retrograde cholangiopancreatography with biliary stent placement into the intrahepatic biloma via the common bile duct. We detected communication between the biloma and the bilateral intrahepatic duct by using a tubogram. Follow-up abdominal computed tomography on PID 47 showed partial thrombosis of the inferior vena cava at the suprahepatic level, and the patient received anticoagulation therapy with low molecular weight heparin and rivaroxaban. As symptomatic improvement was achieved by using conservative management, the percutaneous drains were removed and the patient was discharged on PID 82. [ J Trauma Inj 2014;27:89-93 ]
둔상에 의한 흉부대동맥 손상에서 TEVAR에 관한 임상연구
구관우 ( Gwan Woo Ku ),최진호 ( Jin Ho Choi ),최민석 ( Min Suk Choi ),박상순 ( Sang Soon Park ),설영훈 ( Young Hoon Su ),고승제 ( Seung Je Go ),예진봉 ( Jin Bong Ye ),김중석 ( Joong Suck Kim ),김영철 ( Yeong Cheol Kim ),황정주 ( J 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.4
Purpose: Thoracic aortic injury is a life-threatening injury that has been traditionally treated by using surgical management. Recently, thoracic endovascular aortic repair (TEVAR) has been conducted pervasively as a better alternative treatment method. Therefore, this study will focus on analyzing the outcome of TEVAR in patients suffering from a blunt thoracic aortic injury. Methods: Of the blunt thoracic aortic injury patients admitted to Eulji University Hospital, this research focused on the 11 patients who had received TEVAR during the period from January 2008 to April 2014. Results: Seven of the 11 patients were male. At the time of admission, the mean systolic pressure was 105.64±24.60 mm Hg, and the mean heart rate was 103.64±20.02 per minute. The median interval from arrival to repair was 7 (4, 47) hours. The mean stay in the ICU was 21.82±16.37 hours. In three patients, a chimney graft technique was also performed to save the left subclavian artery. In one patient, a debranching of the aortic arch vessels was performed. In two patients, the left subclavian artery was totally covered. In one patient whose proximal aortic neck length was insufficient, the landing zone was extended by using a prophylactic left subclavian artery to left common carotid artery bypass before TEVAR. There were no operative mortalities, but a patient who was covered of left subclavian artery died from ischemic brain injury. Complications such as migration, endovascular leakage, collapse, infection and thrombus did not occur. Conclusion: Our short-term outcomes of TEVAR for blunt thoracic aorta injury was feasible. Left subclavian artery may be sacrificed if the proximal landing zone is short, but several methods to continue the perfusion should be considered. [ J Trauma Inj 2015; 28: 232-240 ]
예진봉 ( Jin Bong Ye ),설영훈 ( Young Hoon Sul ),문윤수 ( Yun Su Mun ),고승제 ( Seung Je Go ),권오상 ( Oh Sang Kwon ),구관우 ( Gwan Woo Ku ),이민구 ( Min Koo Lee ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.3
Neck trauma is a relatively uncommon but can be a life-threatening injury. Several guidelines for neck trauma is established to recommend a proper management such as no clamping of bleeding vessels, no probing of wounds, Trendelenberg position for preventing venous air embolism. Here, we present a regretful case of 49-year-old man with neck trauma presenting undesired bleeding after probing of wound, and then discuss about treatment guildeline for neck trauma with a review. [ J Trauma Inj 2015; 28: 198-201 ]
김중석 ( Joong Suck Kim ),설영훈 ( Young Hoon Sul ),고승제 ( Seung Je Go ),예진봉 ( Jin Bong Ye ),박상순 ( Sang Soon Park ),구관우 ( Gwan Woo Ku ),김영철 ( Yeong Cheol Kim ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.4
Pelvic bone fracture with unstable vital signs is a life-threatening condition demanding proper diagnosis and immediate treatment. Unlike long bones, the pelvic bone is a three dimensional structure with complex holes and grooves for vessels and nerves. Because of this complexity, a pelvic bone fracture can lead to complicated and serious bleeding. We report a case of a fifty-year-old male suffering from a pelvic bone fracture due to a fall. An imaging study showed fractures of both the superior and the inferior ramus of the pubic bone, with contrast extravasation underneath them, resulting in a large preperitoneal hematoma. He was sent for angiography, which revealed a hemorrhage from a branch of the left obturator artery. Embolization was done with a glue and lipiodol mixture. The patient recovered without complication, and was discharged at four weeks after admission. [ J Trauma Inj 2015; 28: 272-275 ]
예진봉 ( Jin Bong Ye ),설영훈 ( Young Hoon Sul ),고승제 ( Seung Je Go ),권오상 ( Oh Sang Kwon ),김중석 ( Joong Suck Kim ),박상순 ( Sang Soon Park ),구관우 ( Gwan Woo Ku ),이민구 ( Min Koo Lee ),김영철 ( Yeong Cheol Kim ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.3
The primary and secondary survey was designed to identify all of a patient’s injuries and prioritize their management. However 15 to 22.3% of patient with missed injuries had clinically significant missed injuries. To reduce missed injury, special attention should be focused on patients with severe anatomical injury or obtunded. Victims of blunt trauma commonly had multiple system involvement. Some reports indicate that inexperience, breakdown of estalished protocol, clinical error, and restriction of imaging studies may be responsible for presence of missed injury. The best way of reducing clinical significant of missed injuries was repeated clinical assessment. Here we report a case of severe blunt hepatic injury patient and pericardial injury that was missed in primary and secondary survey. After damage control surgery of hepatic injury, she remained hemodynamically unstable. Further investigation found cardiac tamponade during intensive care. This was managed by pericardial window operation through previous abdominal incision and abdominal wound closure was performed. [ J Trauma Inj 2015; 28: 211-214 ]
최석호 ( Seok Ho Choi ),서길준 ( Gil Joon Suh ),김영철 ( Yeong Cheol Kim ),권운용 ( Woon Yong Kwon ),한국남 ( Kook Nam Han ),이경학 ( Kyoung Hak Lee ),이수언 ( Soo Eon Lee ),고승제 ( Seung Je Go ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4
Purpose: Hemorrhage is a main cause of death in trauma patients. The goal of this study is to describe the characteristics of trauma patients with massive bleeding and to evaluate the prognostic factors concerning their survival. Methods: This study was performed retrospectively and included trauma patients with massive bleeding who had been treated from March 2007 to August 2012. The inclusion criterion was patients who received more than 10 U of packed red blood cells within the first 24 hours after visiting the emergency department. Based on their medical records, we collected data in terms of demographic findings, mechanisms of injury, initial clinical and laboratory findings, methods for hemostasis (emergency surgery and/or angioembolization), transfusion, injury severity score (ISS), revised trauma score (RTS) and trauma and injury severity score (TRISS). We used the Mann-Whitney U test and Fisher`s exact test to compare the variables between the patients that survived and those that did not. We performed a logistic regression analysis with the significant variables from the univariate test. Results: Thirty-two(32) patients were enrolled. The main mechanisms of injury were falls and motor vehicle accidents. The mean transfusion amount of packed red blood cells (PRBC) was 17.4 U. The mean elapsed time for the first hemostasis (surgery or embolization) was 3.5 hours. The initial technical success rates were 83.3%(15/18) in angioembolization and 66.7%(8/12) in surgery. The overall mortality rate was 34.4%(11/32). The causes of death were bleeding, brain swelling and multiple organ failure. The ISS(25.5 vs 46.3, p=0.000), TRISS(73.6 vs 45.1, p=0.034) and base excess(<-12 mmol/L, p=0.020) were significantly different between the patients who survived and those who did not. Conclusion: The ISS was a prognostic factor for trauma patients with massive bleeding. (J Trauma Inj 2012;25:247-253)