BACKGROUND A penetrating injury of a hollow viscus is an obvious indication for an exploratory laparotomy,but is not typically an indication for endoscopic treatment.CASE SUMMARY A 27-year-old man visited the emergenc...BACKGROUND A penetrating injury of a hollow viscus is an obvious indication for an exploratory laparotomy,but is not typically an indication for endoscopic treatment.CASE SUMMARY A 27-year-old man visited the emergency department with a self-inflicted abdominal stab wound.Injuries to the colon and ileum were detected,but an injury to the second portion of the duodenum was missed.On the day following admission to our institution,the patient became hemodynamically unstable with massive hematochezia,although there was no evidence of bleeding in the Levin tube or Jackson-Pratt drain.We thus performed an upper gastrointestinal endoscopy and discovered a missed duodenal injury that was actively bleeding.An endoscopic band ligation was performed for hemostasis and closure of the perforation.The patient was subsequently discharged without any complications.CONCLUSION A penetrating injury of the duodenum can be overlooked,so careful abdominal exploration is very important.If a missed duodenal injury is suspected,a cautious endoscopic approach may be helpful.展开更多
BACKGROUND Aortic intramural hematoma(IMH) associated with aortic branch tear and intramurally located pseudoaneurysm after blunt trauma has not been reported.Here,we report a case of progressive type A aortic IMH ass...BACKGROUND Aortic intramural hematoma(IMH) associated with aortic branch tear and intramurally located pseudoaneurysm after blunt trauma has not been reported.Here,we report a case of progressive type A aortic IMH associated with a pseudoaneurysm arising from the injured proximal renal artery after blunt trauma.CASE SUMMARY During logging operations,a 66-year-old man experienced blunt force trauma after being injured by a fallen tree.He arrived at our trauma center with a left flank pain complaint.Computed tomography(CT) revealed a pseudoaneurysm arising from the proximal renal artery(localized within the aortic media) and Stanford type A IMH.A covered stent was deployed along the left main renal artery,bridging the pseudoaneurysm and covering the parent artery,successfully excluding the pseudoaneurysm as confirmed using aortography.However,although the degree of the pseudoaneurysm decreased,follow-up CT revealed remnant pseudoaneurysm,likely caused by an endoleak.Subsequently,a covered stent was additionally installed through the previously deployed covered stent.Successful exclusion of the pseudoaneurysm was confirmed using final aortography.In the 7-mo follow-up CT scan,the IMH and pseudoaneurysm completely disappeared with no evidence of stent-related complications.CONCLUSION Endovascular treatment such as stent-graft placement can be an effective and safe treatment for traumatic renal artery injury.展开更多
文摘BACKGROUND A penetrating injury of a hollow viscus is an obvious indication for an exploratory laparotomy,but is not typically an indication for endoscopic treatment.CASE SUMMARY A 27-year-old man visited the emergency department with a self-inflicted abdominal stab wound.Injuries to the colon and ileum were detected,but an injury to the second portion of the duodenum was missed.On the day following admission to our institution,the patient became hemodynamically unstable with massive hematochezia,although there was no evidence of bleeding in the Levin tube or Jackson-Pratt drain.We thus performed an upper gastrointestinal endoscopy and discovered a missed duodenal injury that was actively bleeding.An endoscopic band ligation was performed for hemostasis and closure of the perforation.The patient was subsequently discharged without any complications.CONCLUSION A penetrating injury of the duodenum can be overlooked,so careful abdominal exploration is very important.If a missed duodenal injury is suspected,a cautious endoscopic approach may be helpful.
文摘BACKGROUND Aortic intramural hematoma(IMH) associated with aortic branch tear and intramurally located pseudoaneurysm after blunt trauma has not been reported.Here,we report a case of progressive type A aortic IMH associated with a pseudoaneurysm arising from the injured proximal renal artery after blunt trauma.CASE SUMMARY During logging operations,a 66-year-old man experienced blunt force trauma after being injured by a fallen tree.He arrived at our trauma center with a left flank pain complaint.Computed tomography(CT) revealed a pseudoaneurysm arising from the proximal renal artery(localized within the aortic media) and Stanford type A IMH.A covered stent was deployed along the left main renal artery,bridging the pseudoaneurysm and covering the parent artery,successfully excluding the pseudoaneurysm as confirmed using aortography.However,although the degree of the pseudoaneurysm decreased,follow-up CT revealed remnant pseudoaneurysm,likely caused by an endoleak.Subsequently,a covered stent was additionally installed through the previously deployed covered stent.Successful exclusion of the pseudoaneurysm was confirmed using final aortography.In the 7-mo follow-up CT scan,the IMH and pseudoaneurysm completely disappeared with no evidence of stent-related complications.CONCLUSION Endovascular treatment such as stent-graft placement can be an effective and safe treatment for traumatic renal artery injury.
