Nonoperative management of colon and mesocolon injuries caused by blunt trauma: three case reports

Lee Naa,Jeong Euisung,Jang Hyunseok,박윤철,조영권,김정철 대한외상학회 2022 大韓外傷學會誌 Vol.35 No.4

The therapeutic approach for colon injury has changed continuously with the evolution of management strategies for trauma patients. In general, immediate laparotomy can be considered in hemodynamically unstable patients with positive findings on extended focused assessment with sonography for trauma. However, in the case of hemodynamically stable patients, an additional evaluation like computed tomography (CT) is required. Surgical treatment is often required if prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation are observed. However, immediate intervention in hemodynamically stable patients without indications for surgical treatment remains questionable. Three patients with colon and mesocolon injuries caused by blunt trauma were treated by nonoperative management. At the time of admission, they were alert and their vital signs were stable. Colon and mesocolon injuries, large hematoma, colon wall edema, and/or ischemia were revealed on CT. However, no prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation were observed. In two cases, conservative treatment was performed without worsening abdominal pain or laboratory tests. Follow-up CT showed improvement without additional treatment. In the third case, follow-up CT and percutaneous drainage were performed in considering the persistent left abdominal discomfort, fever, and elevated inflammatory markers of the patient. After that, outpatient CT showed improvement of the hematoma. In conclusion, nonoperative management can be considered as a therapeutic option for mesocolon and colon injuries caused by blunt trauma of selected cases, despite the presence of large hematoma and ischemia, if there are no clear indications for immediate intervention.

Abdominal compartment syndrome in critically ill patients

장현석,Lee Naa,정의성,박윤철,조영권,김정철,김도완 대한중환자의학회 2023 Acute and Critical Care Vol.38 No.4

Intra-abdominal hypertension can have severe consequences, including abdominal compartment syndrome, which can contribute to multi-organ failure. An increase in intra-abdominal hypertension is influenced by factors such as diminished abdominal wall compliance, increased intraluminal content, and certain systemic conditions. Regular measurement of intra-abdominal pressure is essential, and particular attention must be paid to patient positioning. Nonsurgical treatments, such as decompression of intraluminal content using a nasogastric tube, percutaneous drainage, and fluid balance optimization, play crucial roles. Additionally, point-of-care ultrasonography aids in the diagnosis and treatment of intra-abdominal hypertension. Emphasizing the importance of regular measurements, timely decompressive laparotomy is a definitive, but complex, treatment option. Balancing the urgency of surgical intervention against potential postoperative complications is challenging.

한국의 새마을운동과 가나의 NRPRP의 비교 연구 : 농촌빈곤 감소와 지역사회개발에 대한 교훈

Okine Margaret Naa Ayeley,이정주(Jeong-Ju Lee) 한국비교정부학회 2021 한국비교정부학보 Vol.25 No.1

(Purpose) Korea and Ghana shared a similar level of development with GNP per capita of approximately $83in 1961. The Saemaul Undong, which began in the 1970s, contributed to poverty reduction, improved living conditions, high economic growth, and ultimately the transformation of Korea into a developed country, while Ghana remained a developing and aid-dependent or recipient country with high poverty levels especially in rural areas. This study aims to suggest directions for programs for sustainable poverty reduction and community development in the rural areas of Ghana based on a comparison of Korea’s Saemaul Undong and Ghana’s Northern Region Poverty Reduction Programme (NORPREP). (Design/methodology/approach) This study used a qualitative research method, conducting case studies of Saemaul Undong and NORPREP. It focused on three criteria: self-help approach, institutional coordination, and implementation approach for both programs, and takes policy suggestions into consideration to apply success factors of Saemaul Undong to NORPREP. (Findings) This study found that there are both commonalities and differences in project implementation between Saemaul Undong and NORPREP. Saemaul Undong achieved its targets on poverty reduction and rural community development, which contributed to the development of the country, and while NORPREP also achieved its targets, they had low impact, and the desire to develop the country was not achieved. (Research implication or originality) This study suggests policies for sustainable poverty reduction and community development in rural areas by applying the success factors of the Saemaul Undong to improve the NORPREP in Ghana.

Prediction of Mid-term Platelet Transfusion in Stable Trauma Patients Using Rotational Thromboelastometry

Lim Ha Jin,Jang Hyunseok,Lee Naa,Jeong Euisung,Park Yunchul,Jo Younggoun,Kim Jungchul,Lee Young Eun,Choi Hyun-Jung,Kee Seung-Jung,Shin Jong Hee,Shin Myung Geun 대한진단검사의학회 2024 Annals of Laboratory Medicine Vol.44 No.1

Background: Rotational thromboelastometry (ROTEM; TEM International GmbH, Munich, Germany) is a global coagulation test that guides evidence-based platelet transfusion in trauma patients. We evaluated ROTEM parameters for predicting mid-term (five days) platelet transfusion in trauma patients. Methods: Maximum clot firmness and clot amplitudes after 5, 10, and 15 mins (A5, A10, and A15, respectively) of fibrin-specific ROTEM (FIBTEM) and extrinsically activated ROTEM (EXTEM) were retrospectively collected from 82 hospitalized, stable, non-bleeding trauma patients after successful initial resuscitation. Platelet-specific ROTEM (PLTEM) was calculated by subtracting FIBTEM from EXTEM. Platelet transfusions were reviewed for five days after ROTEM. Results: The areas under the curve for FIBTEM, EXTEM, and PLTEM predicting platelet concentrate transfusion of >12 U at mid-term were 0.915–0.923, 0.878–0.896, and 0.551–0.735, respectively. FIBTEM and EXTEM parameters were comparable to those of fibrinogen, fibrin/fibrinogen degradation products, D-dimer, and antithrombin III. Strong correlations (r>0.7) were noted between platelet count and EXTEM (A5, A10, and A15) or PLTEM (A5), platelet function (per platelet count) and EXTEM (A10 and A15), and fibrinogen levels and all FIBTEM parameters. Conclusions: FIBTEM and EXTEM can reliably predict mid-term platelet transfusion in trauma patients. FIBTEM, EXTEM, and PLTEM parameters correlate with conventional coagulation tests (platelets and fibrinogen).

Very large haematoma following the nonoperative management of a blunt splenic injury in a patient with preexisting liver cirrhosis: a case report

( Euisung Jeong ),( Younggoun Jo ),( Yunchul Park ),( Jungchul Kim ),( Hyunseok Jang ),( Naa Lee ) 대한외상학회 2022 大韓外傷學會誌 Vol.35 No.1

The spleen is the most commonly injured organ after blunt abdominal trauma. Nonoperative management (NOM) is the standard treatment for blunt splenic injuries in haemodynamically stable patients without peritonitis. Complications of NOM include rebleeding, new pseudoaneurysm formation, splenic abscess, and symptomatic splenic infarction. These complications hinder the NOM of patients with blunt splenic injuries. We report a case in which a large haemorrhagic fluid collection that occurred after angio-embolisation was resolved by percutaneous drainage in a patient with liver cirrhosis who experienced a blunt spleen injury.

Traumatic abdominal wall hernia with hemoperitoneum caused by blunt injury: laparoscopic exploration with mini-laparotomy repair. A case report

( Euisung Jeong ),( Hyunseok Jang ),( Younggoun Jo ),( Yunchul Park ),( Naa Lee ),( Jungchul Kim ) 대한외상학회 2022 大韓外傷學會誌 Vol.35 No.1

Traumatic abdominal wall hernia is a very rare clinical entity. Herein, we report the case of a patient who was transferred from a local clinic to the emergency department because of left lower abdominal pain. Initially, an intra-abdominal hematoma was observed on computed tomography and no extravasation was noted. Conservative treatment was initiated, and the patient’s symptoms were slightly relieved. However, though abdominal pain was relieved during the hospital stay, bowel herniation was suspected in the left periumbilical area. Follow-up computed tomography showed traumatic abdominal wall hernia with hemoperitoneum in the abdomen. We performed a laparoscopic exploration of the injury site and hernia lesion. The anterior abdominal wall hernia was successfully closed.