Blunt traumatic injury in a pediatric patient treated with simultaneous damage control laparotomy, thoracotomy and transcatheter arterial embolization

Author:

Tomonaga Ayumi1,Nagao Tsuyoshi1,Kono Kaori1,Kanda Tomoki1,Ito Kaori1

Affiliation:

1. Teikyo University School of Medicine

Abstract

Abstract Background: The hybrid emergency room system (HERS) is a single trauma resuscitation room with computed tomography (CT) scanner, fluoroscopy, operating room, and angiography suite allowing surgeons and interventional radiologists (IRs) to obtain imaging studies and perform simultaneous major surgery and endovascular procedures in one room. We report a pediatric patient who suffered severe blunt trauma who underwent simultaneous damage control laparotomy with thoracotomy and endovascular treatment in the HERS. Case presentation: An 8-year-old male was struck and run over (chest and abdomen) by a vehicle. The patient was admitted to the HERS from the ambulance in hemodynamic shock. Focused Assessment of Sonography for Trauma revealed intraabdominal free fluid. Blood gas analysis showed lactic acidosis. The patient was intubated. The massive blood transfusion protocol was activated. Fluoroscopy confirmed no major injuries in the chest and pelvis and exploratory laparotomy was performed which revealed a liver injury (Abbreviated Injury Scale [AIS] 5) and splenic injury (AIS 2) with 1,000 ml of free intraabdominal blood. Perihepatic packing was performed. Simultaneously, IRs performed transcatheter arterial embolization of small branches of the right hepatic and subdiaphragmatic arteries. Subsequently, whole-body CT scan with intravenous contrast was performed which revealed a massive right hemopneumothorax with the extravasation of contrast medium from a right inferior pulmonary artery branch. Right anterolateral thoracotomy was immediately performed. A large laceration of the right lung S6 (AIS 4) was sutured (Injury Severity Score 42, Revised Trauma Score 1.9, TRISS Probability of survival 0.08). The chest and abdomen were temporarily closed, and the patient transferred to the ICU from the HERS. The right chest was closed on hospital day (HD) 2 and the abdomen closed on HD 3. The patient was extubated on HD 6. The postoperative course was complicated by. refractory right atelectasis. High-flow oxygen therapy and respiratory physiotherapy were continued. The patient was discharged home on HD26. Conclusions: The HERS may be useful not only for adult trauma patients but also for severely injured pediatric trauma patients. Protocolized trauma care in the HERS to facilitate collaboration among multiple disciplines and specialties is essential.

Publisher

Research Square Platform LLC

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3