• Journal of Trauma and Injury
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• v.25 no.4
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• pp.261-266
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• 2012

Purpose: Traumatic pancreatic injury is not common in abdominal trauma injury. However, the morbidity and the mortality rates of patients with pancreatic injury, which are related with difficulties of initial assessment, establishment of diagnosis, and treatment are relatively high. The aim of this study is to review our institution's experience and suggest a diagnosis and therapeutic algorithm for use in cases involving traumatic pancreatic injury. Methods: Eighteen(18) patients with blunt pancreatic injury from January, 2004 to October 2012 were included in this study. We analyzed treatment and diagnosis method, other organ injury, treatment interval, hospital stay and complications retrospectively. Results: Nine patients were treated with conservative medication and another nine patients were treated surgically. Complications occurred in nine patients, and one patient died due to intraventricular hemorrhage and subdural hemorrhage with multiple organ failure. Delayed surgery was performed in three cases. The early and delayed surgery groups showed difference in hospital stay and intensive care unit stay. Delayed surgery was associated with a longer hospital stay (p=0.007) than immediate surgery. Conclusion: In blunt pancreatic trauma, proper early diagnosis and prompt treatment are recommended necessity. Based on this review of our experience, we also suggest the adoption of our institution's algorithm for cases involving traumatic pancreatic injury.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.209-216
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• 2012

Purpose: The objectives of this study are to classify chronic subdural hematomas based on brain computerized tomographic scan (CT scan) findings and to determine the mechanism of evolution and treatment methods. Methods: One hundred thirty-nine patients who were diagnosed with a chronic subdural hematoma and who available for follow up assessment 6 months post-surgery were analyzed retrospectively. The presence of trauma and past medical history were reviewed and evaluation criteria based on brain CT scan findings were examined. Results: Initial brain CT scans revealed a chronic subdural hematoma in 106 patients, a subdural hygroma in 24 patients, and an acute subdural hematoma in 9 patients. In all cases where the initial acute subdural hematoma had progressed to a chronic subdural hematoma, final was a hypo-density chronic subdural hematoma. In case where the initial subdural hygroma had progressed to a chronic subdural hematoma, the most cases of hematoma were hyper-density and mixed-density chronic subdural hematoma. In total, 173 surgeries were performed, and they consisted of 97 one burr-hole drainages, 70 two burr-hole drainages and 6 craniotomies. Conclusion: This study demonstrates that rebleeding and osmotic effects are mechanisms for enlarging of a chronic subdural hematoma. In most cases, one burr-hole drainage is a sufficient for treatment. However, in cases of mixed or acute-on-chronic subdural hematomas, other appropriate treatment strategies are required.

• Journal of Trauma and Injury
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• v.22 no.2
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• pp.227-232
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• 2009

Purpose: Numerous experimental studies have shown the benefits of treating thermal burns by cooling. Nevertheless, few studies have shown the clinical effect of cooling therapy on thermal burns. This study aimed to identify the clinical effect of immediate cooling therapy. Methods: The research was conducted as a retrospective, case-control study. All patients had thermal injuries characterized as a superficial second-degree burn. In the cooling group, 14 patients had first-aid cooling therapy delivered by either parents, caregivers, general practitioners, local hospitals, and/or Myongji hospital. Included in the study were 22 control patients who were not treated with any cooling therapies. Other clinical factors, such as age, sex, cause of burn injury, and burn area (Total Body Surface Area %), were taken into consideration. The duration of treatment was defined as the time from the occurrence of the injury to the presence of complete re-epithelialization, as confirmed by two surgeons. Results: The duration of treatment in the cooling group was significantly less than that the control group (p<0.05). Conclusion: Cooling therapy as an initial emergent treatment is clinically effective for superficial second-degree burn injuries.

• Journal of Trauma and Injury
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• v.22 no.1
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• pp.103-107
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• 2009

Purpose: There are no reports on amusement-park-related injuries in Korea. Thus, the objective of this study was to describe traumatic injury patterns that occurring in an amusement park. Methods: The medical records of an infirmary were retrospectively reviewed. From January 1, 2008, to December 31 2008, patients who were transferred to the nearest emergency departments of hospitals for the purpose of further test and treatment were enrolled. Demographics, injury types and involved parts of the body were analyzed. Results: A total of 3,608 patients visited an infirmary for traumatic injury and about two-thirds had soft issue injuries. Of those, 191 patients (5.3%) were transferred to the emergency department of a hospital. Of the patients who were transferred to a hospital, laceration and contusion were the responsible injuries for about half. Laceration was the most common injury in pediatric patients, and a sprain or a strain was the most common in adult patients. The most commonly injured parts of the body were the extremities in adult patients. However, in pediatric patients, injuries of the head, face and neck were similar to injuries of the extremities. Conclusion: Soft tissue injury was the most common amusement-park-related injury. Laceration was the most common reason to transfer a patient to a hospital. There were differences in injury type and injured part of the body between adult and pediatric patients.

• Journal of Trauma and Injury
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• v.22 no.1
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• pp.119-122
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• 2009

Traumatic abdominal wall hernia after blunt abdominal trauma is rare. The prevalence of traumatic abdominal wall hernia in published series is approximately 1%. Recently, by the use of computed tomography has increased the number of occult traumatic abdominal wall hernias (TAWH). A 47-year-old woman presented to the emergency room soon after a traffic accident. She was fully conscious and complained of diffuse, dull, abdominal pain. She had a seat belt on at the time of the accident. Initial computed tomography showed that the lower left abdominal wall had a defect and that a part of the small bowel had herniated through the defect. During the operation, we made an incision at the defect site and confirmed the defect. The defect size was about $15{\times}5cm$. The muscle layers were repaired in layers with absorbable sutures. Prolen mesh was layed down and fixed on the site of the repaired muscle defect. After 6 months, hernia had not recurred, and no weakness of the repaired abdominal wall layers was identified. The patient's postoperative body functions were normal.

• Journal of Trauma and Injury
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• v.22 no.2
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• pp.161-166
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• 2009

Purpose: This study was conducted to analyze chest-trauma patients and the old-aged patients with a traumatic hemopneumothorax. Methods: We reviewed the medical records of 101 chest-trauma patients admitted to the department of cardiovascular and thoracic surgery from June 1999 to November 2008. We evaluated the general characteristics of the chest-trauma patient, especially those of old-aged patients with a traumatic hemopneumothorax. Results: Rib fracture was observed in 99 of the cases, the location distribution was right: left =261: 255, with right being dominant. Rib fractures commonly involved the 4th and the 7th rib. The average number of rib fractures was 5.1, and the average number of rib fractures in the old-aged patients was significantly higher than that in the non-old-aged patients (p=0.04). There were 17 cases of a hemopnuemothorax in old-aged patients, 52 cases in non-old-aged patients. The blood loss through the chest tube for old-aged patients was significantly more than that for the non-old-aged patients, and the initial hemoglobin level was lower in the old-aged patients. Conclusion: Elderly trauma patients are more likely to die after trauma than other age groups. Even with relatively stable vital signs, invasive hemodynamic monitoring and intensive treatment are recommended.

• Journal of Trauma and Injury
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• v.26 no.1
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• pp.22-25
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• 2013

Severe blunt abdominal trauma frequently involves the liver. The development of nonsurgical treatment of liver trauma has led to more frequent appearance of unusual complications. A hepatic arterioportal fistula (APF) is a rare complication of liver trauma. We present a case of traumatic APF in a patient with liver trauma. A 31-year-old male visited our emergency department with pain in the right upper abdomen following a traffic accident. Initial physical exam and abdominal computed tomography (CT) revealed liver laceration with hemoperitoneum. An abdominal CT obtained on day 11 revealed early opacification of the right portal vein on the arterial phase. After we had come to suspect an APF of the liver, its presence was confirmed on angiography. It was subsequently managed by using transcatheter coil embolization. In patients with portal hypertension and no evidence or history of cirrhosis, one should consider an APF as a potential etiology if history of liver biopsy or penetrating trauma exists. In a patient with liver trauma, serial abdominal CT is important for early detection and treatment of an APF.

• Journal of Trauma and Injury
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• v.26 no.1
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• pp.1-5
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• 2013

Purpose: The base deficit (BD) at admission in severely injured patients has been shown to predict the adequacy of resuscitation and outcome, but this relationship is not well established in the Korean experience. The purpose of this study was to define the association between arterial blood gas (ABG) values and the mortality for patients with severe blunt trauma at a developing trauma center in Korea. Methods: A retrospective review of 415 adult patients with severe blunt trauma was conducted using electronic medical records from Jan. 2010 to Dec. 2011. Results: A total of 256 patients had ABG drawn within 1 hour of arrival. Patients who expired displayed a higher lactate level (4.86 vs. 3.31, p<0.0001), a worse BD (-7.99 vs. -5.37, p=0.001), and a lower pH (7.31 vs. 7.34, p=0.011) at arrival compared with those who survived. A statistically significant association was also observed between BD and blood product usage (p=0.001). Conclusion: The base deficit at admission is a useful marker of mortality and outcome in severely injured patients with blunt trauma in Korea.

• Journal of Trauma and Injury
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• v.26 no.1
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• pp.26-29
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• 2013

We describe the case of a 56-year-old man who had been shot by a pneumatic nail gun in the chest during work. He had removed the nail by himself immediately at the accident field. He visited to the emergency department of a local hospital and, after a simple dressing and simple history had been taken, he was referred to our emergency department for penetrating thoracic injury. Immediately, Transthoracic echocardiography were done and showed moderate hemopericardium. Patient had been hydrated and transported to the operating room. After cardiac wound repaired by midsternotomy, the patient was discharged on the 13th postoperative day without complications except mild mitral valve regurgitation.

• Journal of Trauma and Injury
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• v.26 no.1
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• pp.18-21
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• 2013

Pancreatic injury following blunt abdominal trauma is rare, but it has high morbidity and mortality. Various treatments have been attempted, but none has yet been clearly established. The pancreatic neck transection is usually managed by using a distal pancreatectomy with or without a splenectomy. However, pancreatic insufficiency and the risk of post-splenectomy infection remain significant problems. To avoid these problems in patients with a pancreatic neck transection, one may use a pancreaticoenteric anastomosis as a treatment option, but a pancreatic fistula from the pancreaticoenteric anastomosis remains a significant cause of morbidity and mortality. Recently, several reports proposed the binding pancreaticogastrostomy to minimize the possibility of a postoperative pancreatic fistula developing after pancreatic surgery. Thus, we report a case of a traumatic pancreatic neck transection successfully treated with a binding pancreaticogastrostomy.