The diagnosis and evaluation of traumatic abdominal wall hernia can be challenging because of its low incidence and nonspecific clinical presentation. Without a high index of clinical suspicion, the detection of traumatic abdominal wall hernia may be delayed. A 71-year-old female patient was struck in the lower abdomen by a cow horn and initially received only conservative management at a local clinic. However, her pain worsened despite conservative measures, and she developed a reducible bulging mass. Computed tomography revealed an abdominal wall defect with small bowel herniation. She was transferred to our hospital's emergency department, where urgent surgery was performed. A laparotomy was conducted to repair the abdominal wall defect and explore potential intra-abdominal injuries. The defect was successfully repaired, and the patient was discharged without complications on postoperative day 10.

Although liver lacerations are relatively common following blunt trauma, hepatic artery injuries are rare, with only a few cases of hepatic artery dissection caused by blunt trauma reported to date. Due to its rarity, no standardized treatment protocol exists for managing such injuries. We report the case of a 22-year-old female patient referred with a suspected pancreatic injury and liver laceration following blunt trauma. Upon arrival, she presented severe abdominal pain, and a physical examination revealed significant epigastric tenderness. Emergency laparotomy confirmed pancreatic contusion and liver laceration, for which peritoneal irrigation and wide drainage were performed. On postoperative day 17, hepatic artery dissection was incidentally diagnosed with computed tomography, although the patient remained asymptomatic and laboratory tests were within normal limits. Conservative management with an antiplatelet agent was initiated. A follow-up computed tomography scan performed 4 months post trauma demonstrated complete resolution of hepatic artery dissection.

Purpose
Treatment at a dedicated trauma center significantly reduces the mortality rate after trauma. High-quality trauma care requires well-established systems. Moreover, the presence of an on-site trauma surgeon during resuscitation improves outcomes. Although the trauma system history, including trauma centers in South Korea, is relatively short, it has developed rapidly, and trauma surgeons’ roles have also been established. This study aimed to show clinical performance, particularly in trauma surgery, and the outcomes of a regional trauma center serving as a Level 1 trauma center in South Korea.
Methods
Using the Korean Trauma Data Bank, data collected at Ajou University Hospital Trauma Center between January 2020 and December 2022 was retrospectively analyzed. Patients’ demographic characteristics, mechanisms of injuries, trauma surgery types, and outcomes were evaluated.
Results
There were 9,205 patients admitted with trauma, of whom 1,149 underwent trauma surgery (including laparotomy, thoracotomy, pelvic packing, neck surgery, and peripheral vascular surgery). A total of 1,787 trauma surgeries were performed, and the mean time to surgery for hypotensive patients with hemorrhagic shock from arrival was approximately 50 minutes. Damage control surgery including laparotomy, thoracotomy, and pelvic packing accounted for 12% of cases. It was determined that the mortality rate (excluding death on arrival) was less than 5%, and the length of hospital stay decreased over the study period.
Conclusion
Clinical performance, particularly in trauma surgery, conducted by dedicated trauma surgeons, has led to favorable clinical outcomes at a regional trauma center in South Korea.

Xiphoid elongation is a rare phenomenon where the xiphoid process elongates after stimuli such as surgery, physical therapy, or trauma. We report on a 47-year-old male involved in a traffic accident who went into cardiac arrest. He received ongoing cardiopulmonary resuscitation for nine minutes before recovery of cardiac rhythm, and transfer from a local hospital to the trauma center. He received management for hypotensive shock which was temporarily corrected using Resuscitative Endovascular Balloon Occlusion of the Aorta, and underwent trauma laparotomy in which ileocolic artery ligation and a splenectomy were performed. Six months later, the patient reported epigastric discomfort when he bent over. A hard, linear mass was palpated along the upper midline incision scar and a computed tomography scan showed an elongated xiphoid process (10 cm). The patient underwent surgical excision, and electrocauterization of the xiphoid process. This is a rare case of xiphoid elongation following multiple stimuli to the xiphoid process.

A 60-year-old female presented with symptoms consistent with a large bowel obstruction (LBO). Following confirmation of LBO using imaging, she progressed to a laparotomy which potentially revealed a large rectosigmoid tumor with surrounding adhesions, deemed unresectable. The postoperative course was complicated by an enterocutaneous fistula. She was transferred to a tertiary center and underwent a repeat laparotomy which revealed a large fibrotic mass associated with an intra-luminal bread clip (expiry date 2002). This case report details the interesting causative nature of this LBO and the subsequent surgical management, and complicated postoperative course.

Purpose
Despite advances in diagnostic and imaging technologies, the diagnosis of traumatic hollow viscus injury (HVI) remains a great challenge in clinical practice. This study aimed to determine the accuracy of computed tomography (CT) in the diagnosis of HVI in emergent blunt trauma patients.
Methods
The study was conducted on patients with abdominal trauma who were admitted to our center, regional emergency center, Kyung Hee University Medical Center, between January 2008 and December 2018. The clinical data of patients with abdominal trauma who underwent CT and abdominal surgery within 24 hours of hospitalization were analyzed to determine the diagnostic capacity of CT.
Results
In total, 156 patients were included in the study. There were 88 cases of blunt trauma. Among these patients, 27 were diagnosed with HVI using CT, and 38 patients were diagnosed with HVI in the operating room. The median injury severity score for these patients was 10.0, the revised trauma score was 7.841, and the trauma injury severity score was 0.96. The sensitivity and specificity of CT in predicting HVI in these patients were 65.8%, and 96.0%, respectively. The positive and negative predictive values were 92.6%, and 78.7%, respectively.
Conclusion
In urgent situations, CT findings alone are insufficient for diagnosing HVI. Further research on the HVI diagnostic capacity of CT is required.

Citations

• Imaging of Blunt Traumatic Bowel and Mesenteric Injuries
  Fariha Siddiqui, Hannah Moriarty, David D.B. Bates, Christina LeBedis
  Radiologic Clinics of North America.2025; 63(3): 375.     CrossRef
• EVALUATION OF THE DIAGNOSTIC VALUE OF ABDOMINAL AND PELVIC CT SCAN WITH INTRAVENOUS CONTRAST FOR THE DIAGNOSIS OF HOLLOW VISCERA INJURY IN BLUNT TRAUMA PATIENTS
  Hamed Jalali, Naser Masoudi, Ali Enshae
  Studies in Medical Sciences.2024; 35(6): 446.     CrossRef
• Comparison of the diagnostic accuracy of CT scan with oral and intravenous contrast versus CT scan with intravenous contrast alone in the diagnosis of blunt abdominal trauma
  Iraj Golikhatir, Mohammad Sazgar, Fatemeh Jahanian, Seyed Jalal Mousavi Amiri, Hamed Aminiahidashti
  Chinese Journal of Traumatology.2023; 26(3): 174.     CrossRef

Non-operative management of blunt liver injury has been demonstrated as a safe and effective treatment for most grades of injury. As the severity of liver injury increases, so does the risk of complications. A 21-year-old male was brought to the trauma center following a high speed motorbike accident. He underwent a laparotomy and angioembolization for a Grade 4 liver injury. A biloma was diagnosed on Day 18 post injury, and he underwent Endoscopic Retrograde Cholangiopancreatography and biliary stenting which were unsuccessful. There were 2 re-admissions for infected perihepatic collections. In this case, an Endoscopic Retrograde Cholangiopancreatography was not a helpful procedure due to a disconnected liver segment, and morbidity occurred due to instrumentation of the biliary tree (the likely cause of infected biloma). Hepatic resection should be considered for patients who fail non-operative management. Further assessment of efficacy using a larger dataset for analysis is required.

Purpose
The prognosis of an emergent laparotomy in hypotensive patients is poor. This study aimed to review the outcomes of hypotensive patients who had emergent laparotomies and elucidate the risk factors of mortality.
Methods
Patients who underwent an emergent laparotomy from January 2011 to December 2019 were retrospectively reviewed. The exclusion criteria included initial systolic blood pressure > 90 mmHg, aged < 19 years, and cardiac arrest before the laparotomy. Patients were categorized into survival groups (survived or deceased). Univariate and multivariate analyses were conducted to determine the risk factors of mortality. The time from the laparotomy to death was also reviewed and the effect of organ injury.
Results
There were 151 patient records, analyzed 106 survivors, and 45 deceased. The overall mortality was 29.8%. Liver injury was the main organ-related event leading to an emergent laparotomy, and most patients died in the early phase following the laparotomy. Following multivariate analysis, the Glasgow Coma Scale score [odds ratio (95% confidential interval) 0.733 (0.586-0.917), p = 0.007], total red blood cell transfusion volume in 24 hours[1.111 (1.049-1.176), p < 0.001], major bleed from the liver [3.931 (1.203-12.850), p = 0.023], and blood lactate [1.173 (1.009-1.362), p = 0.037] were identified as risk factors for mortality.
Conclusion
Glasgow Coma Scale score, total red blood cell transfusion volume in 24 hours, major bleed from the liver, and lactate were identified as risk factors for mortality. Initial resuscitation and management of liver injuries have major importance following trauma.

Citations

• Effects of prior antiplatelet and/or nonsteroidal anti-inflammatory drug use on mortality in patients undergoing abdominal surgery for abdominal sepsis
  Se Hun Kim, Ki Hoon Kim
  Surgery.2023; 174(3): 611.     CrossRef

Purpose
Managing patients with hemorrhagic shock is mainly dependent on stopping the bleeding as fast as possible. Emergency Department laparotomy (EDL) is considered one of the approaches to control intra-abdominal bleeding rapidly. This study aims to evaluate the outcomes of EDL in a regional trauma center of Pusan National University Hospital in a 4-year period.
Methods
The medical records and data of patients who underwent EDL from January 2016 to December 2019 were analyzed. Patients who underwent preperitoneal pelvic packing only or did not receive surgery immediately after EDL were excluded.
Results
Twenty-four patients who underwent EDL were included in the study. 18 patients had sustained blunt trauma, and 6 suffered from penetrating injuries. Small bowel mesentery and liver injuries were the most frequent. Increase of median systolic blood pressure (SBP) after EDL was 55.5 mmHg. Four (16.7%) out of the 24 survived; one of the four survivors received cardiopulmonary resuscitation (CPR). In the nonsurvivor group, Injury Severity Score was significantly higher (p = 0.013), initial pH was lower (p = 0.035) and the amount of packed red blood cells transfusion after EDL was significantly higher (p = 0.013) than those in the survivor group.
Conclusion
The mortality rate was very high in trauma patients who were required EDL. Although EDL was not proved to be an effective procedure for resuscitation in trauma patients, it could be considered as one of the treatment options for trauma patients in extremis. Further studies are required to examine the effects of EDL.

Pyometra is a rare condition that is defined as the accumulation of purulent material in the uterine cavity caused by an occlusion to the natural drainage of the uterus. Pyometra cases are seldom reported. The symptoms of pyometra may be non-specific, resulting in a delay or misdiagnosis that may subsequently increase the risk of perforation of the pyometra. Once a pyometra ruptures, the patient develops acute abdominal and generalized peritonitis. This case report describes diffuse peritonitis caused by the spontaneous perforation of a pyometra in a woman who was diagnosed preoperatively and treated successfully by emergency laparotomy.

We report a case of delayed presentation of small bowel ischemia following minor mesenteric injury after blunt abdominal trauma. Traumatic small bowel and/or mesenteric injury is rare, and minor mesenteric injury is usually managed conservatively. However, mesenteric injury may cause potentially fatal conditions such as hemorrhages or peritonitis in extremely rare cases and require laparotomy. We present a case of small bowel ischemia that occurred 3 days after minor mesenteric injury from blunt abdominal trauma.

Citations

• Delayed Ileal Hemorrhage After Blunt Abdominal Trauma Successfully Managed With Capsule Endoscopy: A Case Report
  Shimpei Asada, Naoki Kawahara, Koji Morishita, Shusuke Mori
  Cureus.2025;[Epub]     CrossRef