A CASE OF MULTIPLE TRAUMA INVOLVING ADRENAL INJURY SUCCESSFULLY TREATED USING GAUZE PACKING
This report presents a case of adrenal injury with active bleeding that was treated using gauze packing. A 21-year-old man who had been involved in a motor vehicle accident was transferred to our hospital. Abdominal contrast-enhanced computed tomography revealed lung injuries, liver injuries, right...
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| Published in | Journal of the Japanese Association for the Surgery of Trauma Vol. 28; no. 3; pp. 295 - 298 |
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| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
The Japanese Association for the Surgery of Trauma
20.07.2014
一般社団法人 日本外傷学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-6264 2188-0190 |
| DOI | 10.11382/jjast.28.295 |
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| Abstract | This report presents a case of adrenal injury with active bleeding that was treated using gauze packing. A 21-year-old man who had been involved in a motor vehicle accident was transferred to our hospital. Abdominal contrast-enhanced computed tomography revealed lung injuries, liver injuries, right renal injury, and adrenal injury with active bleeding ; therefore, an emergency laparotomy was performed. The retroperitoneal pressure suppressed the bleeding due to the adrenal injury. However, dissection into the retroperitoneum to repair the renal injury resulted in loss of the compressive effect of the adjacent structures ; therefore, the adrenal injury had to be repaired along with the hepatic injury. Gauze packing was effective, and aortography did not reveal any extravasation. The findings of this case, suggest that gauze packing should be considered for treating adrenal injury with active bleeding, especially in cases in which open surgery is performed before angiography. |
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| AbstractList | This report presents a case of adrenal injury with active bleeding that was treated using gauze packing. A 21-year-old man who had been involved in a motor vehicle accident was transferred to our hospital. Abdominal contrast-enhanced computed tomography revealed lung injuries, liver injuries, right renal injury, and adrenal injury with active bleeding ; therefore, an emergency laparotomy was performed. The retroperitoneal pressure suppressed the bleeding due to the adrenal injury. However, dissection into the retroperitoneum to repair the renal injury resulted in loss of the compressive effect of the adjacent structures ; therefore, the adrenal injury had to be repaired along with the hepatic injury. Gauze packing was effective, and aortography did not reveal any extravasation. The findings of this case, suggest that gauze packing should be considered for treating adrenal injury with active bleeding, especially in cases in which open surgery is performed before angiography. This report presents a case of adrenal injury with active bleeding that was treated using gauze packing. A 21-year-old man who had been involved in a motor vehicle accident was transferred to our hospital. Abdominal contrast-enhanced computed tomography revealed lung injuries, liver injuries, right renal injury, and adrenal injury with active bleeding ; therefore, an emergency laparotomy was performed. The retroperitoneal pressure suppressed the bleeding due to the adrenal injury. However, dissection into the retroperitoneum to repair the renal injury resulted in loss of the compressive effect of the adjacent structures ; therefore, the adrenal injury had to be repaired along with the hepatic injury. Gauze packing was effective, and aortography did not reveal any extravasation. The findings of this case, suggest that gauze packing should be considered for treating adrenal injury with active bleeding, especially in cases in which open surgery is performed before angiography. 活動性出血を伴う副腎損傷に対してガーゼパッキングが奏功した多発外傷例を報告する．症例は21歳，男性．交通外傷で当センター搬送となった．造影CT検査にて肺挫傷と肝損傷，活動性出血を伴う右腎臓損傷と右副腎損傷を認め緊急開腹術を施行した．腎の修復の際に後腹膜腔が開放されたため，後腹膜腔による副腎のパッキング効果が期待できないと判断して肝とともにガーゼによるパッキングを行い，引き続き血管内治療に移行した．大動脈造影では副腎からの出血は認められずガーゼパッキングが有効と判断した．本症例のように，血管内治療に先行して開腹術が行われた場合，ガーゼパッキングは有効な一次止血法と考えられた． |
| Author | HATA, Michiaki FUKUSIMA, Hidetada IWAMURA, Asami SEKI, Tadahiko TADA, Yusuke KAWAI, Yasuyuki KITAOKA, Hironori INOUE, Gou OKUCHI, Kazuo MIYAZAKI, Keita NORIMOTO, Kazunobu |
| Author_FL | 川井 廉之 關 匡彦 岩村 あさみ 宮崎 敬太 則本 和伸 福島 英賢 奥地 一夫 北岡 寬教 多田 祐介 畑 倫明 井上 剛 |
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| References | 3) Sinelnikov AO, Abujudeh HH, Chan D, et al : CT manifestations of adrenal trauma : experience with 73 cases. Emerg Radiol 2007 ; 13 : 313-318. 4) Udobi KF, Childs EW : Adrenal crisis after traumatic bilateral adrenal hemorrhage. J Trauma 2001 ; 51 : 597-600. 1) Rana AI, kenney PJ, Lockhart ME, et al : Adrenal gland hematomas in trauma patients. Radiology 2004 ; 230 : 669-675. 8) Smith WR, Moore EE, Osborn P, et al : Retroperitoneal packing as a resuscitation technique for hemodynamically unstable patients with pelvic fractures : report of two representative cases and a description of technique. J Trauma 2005 ; 59 : 1510-1514. 5) 久志本成樹 : ダメージコントロール. 日本Acute Care Surgery学会編. 外傷外科手術スタンダード. 東京 : 羊土社, 2012 : 124-143. 2) Stawicki SP, Hoey BA, Grossman MD, et al : Adrenal gland trauma is associated with high injury severity and mortality. Curr Surg 2003 ; 60 : 431-436. 6) 青木弘道, 守田誠司, 山際武志, ほか : 外傷性副腎損傷に対してTAEを施行した１例. 日外傷会誌 2011 ; 25 : 46-49. 7) 北川喜己, 梛野正人 : 肝損傷. 日本Acute Care Surgery学会編. 外傷外科手術スタンダード. 東京 : 羊土社, 2012 : 144-152. 9) Fowler AM, Burda JF, Kim SK : Adrenal artery embolization : anatomy, indications, and technical considerations. AJR 2013 ; 201 : 190-201. |
| References_xml | – reference: 9) Fowler AM, Burda JF, Kim SK : Adrenal artery embolization : anatomy, indications, and technical considerations. AJR 2013 ; 201 : 190-201. – reference: 1) Rana AI, kenney PJ, Lockhart ME, et al : Adrenal gland hematomas in trauma patients. Radiology 2004 ; 230 : 669-675. – reference: 5) 久志本成樹 : ダメージコントロール. 日本Acute Care Surgery学会編. 外傷外科手術スタンダード. 東京 : 羊土社, 2012 : 124-143. – reference: 6) 青木弘道, 守田誠司, 山際武志, ほか : 外傷性副腎損傷に対してTAEを施行した１例. 日外傷会誌 2011 ; 25 : 46-49. – reference: 8) Smith WR, Moore EE, Osborn P, et al : Retroperitoneal packing as a resuscitation technique for hemodynamically unstable patients with pelvic fractures : report of two representative cases and a description of technique. J Trauma 2005 ; 59 : 1510-1514. – reference: 4) Udobi KF, Childs EW : Adrenal crisis after traumatic bilateral adrenal hemorrhage. J Trauma 2001 ; 51 : 597-600. – reference: 2) Stawicki SP, Hoey BA, Grossman MD, et al : Adrenal gland trauma is associated with high injury severity and mortality. Curr Surg 2003 ; 60 : 431-436. – reference: 3) Sinelnikov AO, Abujudeh HH, Chan D, et al : CT manifestations of adrenal trauma : experience with 73 cases. Emerg Radiol 2007 ; 13 : 313-318. – reference: 7) 北川喜己, 梛野正人 : 肝損傷. 日本Acute Care Surgery学会編. 外傷外科手術スタンダード. 東京 : 羊土社, 2012 : 144-152. |
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| SubjectTerms | adrenal injury damage control surgery gauze packing ガーゼパッキング ダメージコントロールサージェリー 副腎損傷 |
| Title | A CASE OF MULTIPLE TRAUMA INVOLVING ADRENAL INJURY SUCCESSFULLY TREATED USING GAUZE PACKING |
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