Journal of Acute Care Surgery

Trauma, Organ(liver, bowel, kideny etc.)

Delayed Chylothorax Following Blunt Chest Trauma Treated with Repeated Lymphangiography: A Case Presentation: Gayoung Kim, Dongsub Noh, Bong Man Kim, Yoonjung Heo; J Acute Care Surg 2023;13(1):39-42. Published online March 21, 2023; DOI: https://doi.org/10.17479/jacs.2023.13.1.39

Abstract
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Chylothorax is mostly iatrogenic, with blunt chest trauma being a rare cause. Treatment depends on the volume of drainage. Specifically, conservative treatment, such as total parenteral nutrition and pleural drainage, is performed in cases of low daily output (< 500 mL/day). Patients with persistent chylothorax despite medical treatment or with high daily output (> 1-1.5 L/day) are candidates for surgical or radiological intervention. We present a case of delayed-onset chylothorax after blunt trauma caused by thoracic spine fractures, in which persistent chylothorax was successfully managed with repeated lymphangiography with lipiodol when other treatment modalities failed. The case is peculiar in that the chylothorax occurred 40 days after the initial traumatic event and was treated with lipiodol injection, despite maintaining moderate to high daily output.

Citations

Citations to this article as recorded by

Blunt Chest Trauma and Chylothorax: A Systematic Review
Hiwa O. Abdullah, Fahmi H. Kakamad, Harem K. Ahmed, Bnar J. Hama Amin, Hadi M. Abdullah, Shvan H. Mohammed, Berun A. Abdalla, Sasan M. Ahmed, Marwan N. Hassan, Sarhang S. Abdalla, Yousif M. Mahmood, Kayhan N. Najar, Suhaib H. Kakamad, Bander
Judi Clinical Journal.2025; 1(1): 27. CrossRef

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Trauma, Organ(liver, bowel, kideny etc.)

Determination of Risk Factors for Predicting Bladder-Urethra Injury in Cases of Pelvic Bone Fracture: A Retrospective Single Center Study: Ji Wool Ko, Myoung Jun Kim, Young Un Choi, Hongjin Shim, Hoejeong Chung, Ji Young Jang, Keum Seok Bae, Kwangmin Kim; J Acute Care Surg 2022;12(2):63-69. Published online July 22, 2022; DOI: https://doi.org/10.17479/jacs.2022.12.2.63

Abstract
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Purpose
Pelvis fractures are associated with bladder and urethral injury (BUI). The purpose of this study was to identify risk factors associated with BUI in patients with pelvic fracture.
Methods
Patients (> 18 years) with pelvic injury (N = 314) at our hospital between January 2015 and June 2020 were retrospectively analyzed for age, sex, cause of injury, initial vital signs, urine red blood cell (RBC) count, Glasgow Coma Scale and Abbreviated Injury Scale score, Injury Severity Score, preperitoneal pelvic packing, and femur, lumbar spine, and pelvic fractures.
Results
Compared with the BUI-absent group, the BUI-present group had a greater percentage of patients who were male (79.2% vs. 55.9%; p = 0.026), had a urine RBC count/high power field (HPF) ≥ 30 (94.4% vs. 38.8%; p < 0.001), underwent preperitoneal pelvic packing (37.5% vs. 18.6%; p = 0.035), had symphysis pubis diastasis (33.3% vs. 11.7%; p = 0.008), and had sacroiliac joint dislocation (54.2% vs. 23.4%; p = 0.001). Independent risk factors associated with BUI were symphysis pubis diastasis [odds ratio (OR) was 3.958 (95% confidence interval: 1.191–13.154); p = 0.025] and a urine RBC count/HPF ≥ 30 [OR = 25.415 (95% confidence interval: 3.252–198.637); p = 0.006]. Of those with BUI, 15 patients were diagnosed at the trauma bay, and 9 had a delayed diagnosis.
Conclusion
Patients with pelvic injury who display symphysis pubis diastasis or have a urine RBC count/ HPF ≥ 30 are at higher risk of BUI, therefore, further BUI investigations should be considered.

Citations

Citations to this article as recorded by

Hematuria as a Screening Tool for Bladder and Urethral Injuries in Pelvic Trauma: A Sensitivity and Specificity Analysis
Md Habibur Rahman, Muktadir Tamim, Goutom Mukharzi
TAJ: Journal of Teachers Association.2024; 37(2): 802. CrossRef

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Critical care, Shock

Takotsubo Syndrome Resulting from Traumatic Multiple Rib Fractures: Yoo Jin Jung, Su Wan Kim, Joon Hyouk Choi; J Acute Care Surg 2018;8(1):30-32. Published online April 30, 2018; DOI: https://doi.org/10.17479/jacs.2018.8.1.30

Abstract
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Takotsubo syndrome, also known as stress-induced cardiomyopathy, is a transient cardiac syndrome that mimics acutecoronary syndrome. This condition should be suspected if the patient presents with chest pain after intense emotional stress, accompanied by an abnormal electrocardiogram, elevated levels of myocardial enzymes, and left ventricular apical akinesia on echocardiography. Coronary angiography should be performed for prompt differentiation from ischemic heart disease. A 77-year-old female presented with traumatic multiple fractures of the left sixth and seventh ribs resulting from a violent strike. Clinical findings of physical examination, laboratory tests, electrocardiogram, and coronary angiography provided the diagnosis of Takotsubo syndrome. We performed conservative management including pain control, and the patient was uneventfully discharged seven days after admission.