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Experiencing cardiac arrest during surgical exploration in hemodynamically stable patients with multiple stab wounds, including lower extremity in Korea: a case report

  • Jung Rae Cho (Department of Surgery, Trauma Center, Dankook University Hospital) ;
  • Dae Sung Ma (Department of Thoracic and Cardiovascular Surgery, Trauma Center, Dankook University Hospital)
  • Received : 2024.04.24
  • Accepted : 2024.05.31
  • Published : 2024.06.30

Abstract

Stab wounds, particularly those affecting multiple body regions, present considerable challenges in trauma care. This report describes a case of sustained self-inflicted stab injuries to the abdomen and thighs of a 23-year-old male patient. Although the patient's vital signs were stable and bleeding was minimal from thigh wounds without overt signs of vascular injury, the patient experienced a sudden, profound hemorrhage from the right thigh, leading to cardiac arrest. Successful resuscitation was followed by surgical repair of a right superficial femoral arterial injury accompanying a resuscitative endovascular balloon of the aorta. Subsequent lower extremity computed tomography angiography revealed no additional vascular abnormalities. The patient was discharged in stable condition on the 12th postoperative day. This case underscores the unpredictability of stab wound trajectories and the potential for hidden vascular injuries, even in the absence of immediate life-threatening signs. It also emphasizes the critical role of advanced imaging modalities, such as computed tomography angiography, in identifying concealed injuries, and the importance of strategic intraoperative techniques, including resuscitative endovascular balloon occlusion of the aorta, in achieving favorable patient outcomes.

Keywords

References

  1. Derbel B, Mazzaccaro D, Krarti N, et al. Penetrating vascular injuries of the lower limbs after stab wounds: predictive factors of limb loss and mortality. J Clin Med 2023;12:3476. 
  2. Alarhayem AQ, Cohn SM, Cantu-Nunez O, Eastridge BJ, Rasmussen TE. Impact of time to repair on outcomes in patients with lower extremity arterial injuries. J Vasc Surg 2019;69:1519-23. 
  3. Liang NL, Alarcon LH, Jeyabalan G, Avgerinos ED, Makaroun MS, Chaer RA. Contemporary outcomes of civilian lower extremity arterial trauma. J Vasc Surg 2016;64:731-6. 
  4. Tan TW, Joglar FL, Hamburg NM, et al. Limb outcome and mortality in lower and upper extremity arterial injury: a comparison using the National Trauma Data Bank. Vasc Endovascular Surg 2011;45:592-7. 
  5. Topal AE, Eren MN, Celik Y. Lower extremity arterial injuries over a six-year period: outcomes, risk factors, and management. Vasc Health Risk Manag 2010;6:1103-10. 
  6. Kauvar DS, Sarfati MR, Kraiss LW. National trauma databank analysis of mortality and limb loss in isolated lower extremity vascular trauma. J Vasc Surg 2011;53:1598-603. 
  7. O'Shea AE, Lee C, Kauvar DS. Analysis of concomitant and isolated venous injury in military lower extremity trauma. Ann Vasc Surg 2022;87:147-54. 
  8. Franz RW, Shah KJ, Halaharvi D, Franz ET, Hartman JF, Wright ML. A 5-year review of management of lower extremity arterial injuries at an urban level I trauma center. J Vasc Surg 2011;53:1604-10. 
  9. Inaba K, Branco BC, Reddy S, et al. Prospective evaluation of multidetector computed tomography for extremity vascular trauma. J Trauma 2011;70:808-15. 
  10. Chen Zhou ZH, Martinez Chamorro E, Ibanez Sanz L, Sanz De Lucas R, Chico Fernandez M, Borruel Nacenta S. Traumatic arterial injuries in upper and lower limbs: what every radiologist should know. Emerg Radiol 2022;29:781-90. 
  11. Adibi A, Krishnam MS, Dissanayake S, et al. Computed tomography angiography of lower extremities in the emergency room for evaluation of patients with gunshot wounds. Eur Radiol 2014;24:1586-93.