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Article: Conservative treatment of blunt traumatic right renal venous pseudoaneurysm: A case report.

Cho, Sung Hoon / Lim, Kyoung Hoon

International journal of surgery case reports

2022 Volume 98, Page(s) 107572

Abstract: Introduction: Venous pseudoaneurysm is uncommon in blunt trauma patients, and renal venous pseudoaneurysm is especially rare, even though renal trauma occurs in approximately 8-10 % of abdominal trauma cases. There is controversy regarding the modality ... ...

Abstract	Introduction: Venous pseudoaneurysm is uncommon in blunt trauma patients, and renal venous pseudoaneurysm is especially rare, even though renal trauma occurs in approximately 8-10 % of abdominal trauma cases. There is controversy regarding the modality of treatment between surgery, conservative care, and radiologic intervention to manage renal venous pseudoaneurysms. We would like to share our experience treating blunt trauma patients having renal venous pseudoaneurysm with conservative care. Presentation of case: A 53-year-old female patient was transferred to our trauma center following a pedestrian accident. Contrast-enhanced abdominal computed tomography (CT) showed right renal injury (grade II) with partial infarction (approximately 30-40 %) and peri-renal hematoma confined to Gerota's fascia without extravasation, a 3 cm sized right renal venous pseudoaneurysm, and a liver laceration (grade III) with a small amount of perihepatic hemoperitoneum. Since her vital signs were stable, with no decrease in the hemoglobin level in the short-term follow-up laboratory test, we decided to treat the patient conservatively in the trauma intensive care unit without angioembolization or surgery. The patient was discharged on the 14th day after OR/IF surgery for a right distal tibiofibular fracture. On a CT scan performed 1 month after discharge, a peri-renal hematoma was no longer observed, and the renal venous pseudoaneurysm had nearly improved. Discussion: Patients with renal arterial injury with unstable vital signs require surgery or angioembolization. Even if vital signs are stable, arterial pseudoaneurysms are more likely to rupture; therefore, surgery or angioembolization is required. In contrast, venous pseudoaneurysms can be managed conservatively compared to intervention or surgery in vitally stable patients because they have a lower possibility of rupture due to relatively low pressure. Conclusion: Renal venous pseudoaneurysms are very rare. Surgery, conservative care, and radiologic intervention should be considered depending on the patient's condition. Because venous blood flow is slower than arterial blood flow, renal venous pseudoaneurysm can be treated with conservative care if there are no injuries requiring further management and if the patient's vital signs are stable.
Language	English
Publishing date	2022-08-31
Publishing country	Netherlands
Document type	Case Reports
ISSN	2210-2612
ISSN	2210-2612
DOI	10.1016/j.ijscr.2022.107572
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Article: Laparoscopic repair of colonoscopy-induced adult Bochdalek hernia: Case report.

Cho, Sung Hoon / Lim, Kyoung Hoon

International journal of surgery case reports

2022 Volume 99, Page(s) 107591

Abstract: Introduction: Bochdalek hernias are congenital diaphragmatic malformations caused by a failure to close the pleuroperitoneal cavity in the posterolateral area. Bochdalek hernias are very rare in adult, with congenital diaphragmatic defects being even ... ...

Abstract	Introduction: Bochdalek hernias are congenital diaphragmatic malformations caused by a failure to close the pleuroperitoneal cavity in the posterolateral area. Bochdalek hernias are very rare in adult, with congenital diaphragmatic defects being even rarer. Presentation of case: A 35-year-old man presented to our emergency room with epigastric pain after colonoscopy. The patient had no history of trauma. Plain chest X-ray revealed bowel gas patterns and haziness in the left lower lung field. Abdominal computed tomography revealed a left diaphragmatic defect in the posterolateral area, with herniation of the omentum and colon. The patient successfully underwent laparoscopic herniorrhaphy. Discussion: The diaphragm comprises fibrous tissue and muscle. Therefore, direct damage by a colonoscope is almost impossible. Normal chest X-ray as a part of a health screening was performed 9 days prior to admission, and the size of the diaphragmatic defect could be covered by the spleen; therefore, the patient was considered hernia-free for over 30 years. Conclusion: We report a rare case of delayed Bochdalek hernia that may have been induced by the difficult insertion of a colonoscopy. Although rare, this disorder should be recognized, examined and treated appropriately to avoid complications.
Language	English
Publishing date	2022-09-05
Publishing country	Netherlands
Document type	Case Reports
ISSN	2210-2612
ISSN	2210-2612
DOI	10.1016/j.ijscr.2022.107591
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Article ; Online: Risk factors of trauma-induced thrombotic microangiopathy-like syndrome: A retrospective analysis.

Lim, Kyoung Hoon / Park, Jinyoung / Cho, Sung Hoon

Medicine

2022 Volume 101, Issue 29, Page(s) e29315

Abstract: Patients with trauma may develop thrombocytopenia. We encountered cases wherein patients experienced symptoms resembling thrombotic microangiopathies (TMAs) following severe trauma. As the condition of these patients did not meet the diagnostic criteria ... ...

Abstract	Patients with trauma may develop thrombocytopenia. We encountered cases wherein patients experienced symptoms resembling thrombotic microangiopathies (TMAs) following severe trauma. As the condition of these patients did not meet the diagnostic criteria of thrombotic thrombocytopenic purpura and there was no mention of trauma among the several causes of TMAs, it was termed as "trauma-induced thrombotic microangiopathy-like syndrome" (t-TMAS). In this study, we aimed to analyze the risk factors that may affect the incidence of t-TMAS in patients with severe trauma. This retrospective study was conducted in the trauma intensive care unit at the Kyungpook National University Hospital between January 2018 and December 2019. The medical records of 1164 of the 1392 enrolled participants were analyzed. To assess the risk factors of t-TMAS, we analyzed age, sex, mechanism of trauma, abbreviated injury scale (AIS) score, injury severity score (ISS), hematological examination, and red blood cell volume transfused in 24 hours. Among the 1164 patients, 20 (1.7%) were diagnosed with t-TMAS. The univariate analysis revealed higher age, ISS, and myoglobin, lactate, creatine kinase-myocardial band (on admission), creatine phosphokinase, lactate dehydrogenase (LDH), and lactate (day 2) levels in the t-TMAS group than in the non-t-TMAS group. The red blood cell volume transfused in 24 hours was higher in the t-TMAS group than in the non-t-TMAS group. t-TMAS was more common in patients with injuries in the chest, abdomen, and pelvis (AIS score ≥3) than in those with head injuries (AIS score ≥3) alone. The higher the sum of AIS scores of the chest, abdomen, and pelvis injuries, the higher the incidence of t-TMAS. Multivariate analysis revealed age, ISS, and LDH level (day 2) to be independent predictors of t-TMAS. Trauma surgeons should consider the possibility of t-TMAS if thrombocytopenia persists without any evidence of bleeding, particularly among older patients with multiple severe torso injuries who have high LDH levels on day 2. Early diagnosis and treatment of t-TMAS could improve patients' prognosis.
MeSH term(s)	Humans ; Injury Severity Score ; Lactates ; Multiple Trauma/diagnosis ; Retrospective Studies ; Risk Factors ; Thrombotic Microangiopathies/epidemiology ; Thrombotic Microangiopathies/etiology
Chemical Substances	Lactates
Language	English
Publishing date	2022-07-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000029315
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Article: Conservative treatment of acute traumatic left renal vein occlusion: Importance of left gonadal vein, case report.

Kwon, Hyung Jun / Lim, Kyoung Hoon

International journal of surgery case reports

2020 Volume 69, Page(s) 10–12

Abstract: Introduction: Isolated acute traumatic renal vein occlusion is rare. As both kidneys have limited capsular and peripelvic vein collaterals, acute renal vein occlusion could lead to renal infarction. However, the left renal vein has potential collateral ... ...

Abstract	Introduction: Isolated acute traumatic renal vein occlusion is rare. As both kidneys have limited capsular and peripelvic vein collaterals, acute renal vein occlusion could lead to renal infarction. However, the left renal vein has potential collateral pathways through the gonadal vein. Presentation of case: A 56-year-old woman was transferred to our trauma center after a pedestrian accident. Computed Tomography (CT) with contrast enhancement showed that no delineation of left renal vein with adjacent retroperitoneal hematoma around renal vessels, but left renal venous flow was being drained through left gonadal vein, therefore, left kidney was not congested. Her serum creatinine concentration was normal. We elected to treat her left renal vein occlusion conservatively because of the collateral pathway into the gonadal vein. Discussion: Collateral pathway of the left renal venous drainage may be well known to urologists or vascular surgeons, but may be unfamiliar to trauma surgeons. Therefore, trauma surgeon's attempts for revascularization of thrombosed left renal vein may lead to massive bleeding or nephrectomy. Conclusion: Acute left renal vein occlusion close to the inferior vena cava can result in temporary venous hypertension and congestion followed by complete or nearly complete return of function as collateral veins enlarge. If the gonadal vein is patent, left renal vein occlusion could be treated conservatively.
Language	English
Publishing date	2020-03-28
Publishing country	Netherlands
Document type	Case Reports
ISSN	2210-2612
ISSN	2210-2612
DOI	10.1016/j.ijscr.2020.03.016
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Article ; Online: Prevalence and clinical impact of vitamin D deficiency in critically ill Korean patients with traumatic injuries: a single-center, prospective, observational study.

Lim, Kyoung Hoon / Jang, Jihoon / Park, Jinyoung

Acute and critical care

2021 Volume 36, Issue 2, Page(s) 92–98

Abstract: Background: This study investigated the prevalence and impact of 25-hydroxyvitamin D (25(OH) vitamin D) deficiency in critically ill Korean patients with traumatic injuries.: Methods: This prospective observational cohort study assessed the 25(OH) ... ...

Abstract	Background: This study investigated the prevalence and impact of 25-hydroxyvitamin D (25(OH) vitamin D) deficiency in critically ill Korean patients with traumatic injuries. Methods: This prospective observational cohort study assessed the 25(OH) vitamin D status of consecutive trauma patients admitted to the trauma intensive care unit (TICU) of Kyungpook National University Hospital between January and December 2018. We analyzed the prevalence of 25(OH) vitamin D deficiency and its impact on clinical outcomes. Results: There were no significant differences in the duration of mechanical ventilation (MV), lengths of TICU and hospital stays, and rates of nosocomial infection and mortality between patients with 25(OH) vitamin D <20 ng/ml and those with 25(OH) vitamin D ≥20 ng/ml within 24 hours of TICU admission. The duration of MV and lengths of TICU and hospital stays were shorter and the rate of nosocomial infection was lower in patients with 25(OH) vitamin D level ≥20 ng/ml on day 7 of hospitalization. The duration of MV, lengths of TICU and hospital stays, and nosocomial infection rate were significantly lower in patients with increased concentrations compared with those with decreased concentrations on day 7 of hospitalization, but the mortality rate did not differ significantly. Conclusions: The 25(OH) vitamin D level measured within 24 hours after TICU admission was unrelated to clinical outcomes in critically ill patients with traumatic injuries. However, patients with increased 25(OH) vitamin D level after 7 days of hospitalization had better clinical outcomes than those with decreased levels.
Language	English
Publishing date	2021-04-29
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	3003021-3
ISSN	2586-6060 ; 2586-6052
ISSN (online)	2586-6060
ISSN	2586-6052
DOI	10.4266/acc.2020.00801
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Article ; Online: Comparison of incidence and outcome between occupational and non-occupational motorcycle injuries in Korea: A 7-years observational study.

Moon, Sungbae / Ryoo, Hyun Wook / Cho, Jae Wan / Jung, Haewon / Seo, Kang Suk / Lim, Kyoung Hoon

PloS one

2023 Volume 18, Issue 3, Page(s) e0283512

Abstract: Motorcycles are widely used in various workplaces. Motorcycle use for occupational purposes continues to increase owing to growing e-commerce. Here, we aimed to highlight the importance of occupational motorcycle injuries by analyzing their epidemiologic ...

Abstract	Motorcycles are widely used in various workplaces. Motorcycle use for occupational purposes continues to increase owing to growing e-commerce. Here, we aimed to highlight the importance of occupational motorcycle injuries by analyzing their epidemiologic characteristics and outcomes. We analyzed retrospective data from the Emergency Department-based Injury In-depth Surveillance program from 2012 to 2018. Motor vehicle injuries involving riders aged ≥16 years were included. Patients were divided into occupational motorcycle and non-occupational motorcycle injury groups based on whether or not the injury occurred during work time. General characteristics, injury details, and clinical outcomes such as injury severity and in-hospital mortality were analyzed. Of the 37,194 study patients, 24.2% (8,991) experienced occupational motorcycle injuries. The number of injuries in both groups increased yearly, as did the proportion of occupational injuries among total injuries. In both the groups, patients aged 20-29 years had the highest proportion of injuries. Regarding collision pattern and injury counterpart, side-to-side collisions and injuries involving small four-wheel vehicles were the most frequent. Alcohol intake was significantly lower, while helmet usage was higher in the occupational motorcycle injury group. Moreover, patients with occupational motorcycle injuries had lower injury severity, admission rate, and in-hospital mortality. On multivariable logistic regression analysis, increasing age, time of the injury, alcohol intake, not using a helmet, and collision with a human or animal were associated with higher odds of severe injury. Patients with occupational injuries had higher helmet usage, lower injury severity, lower mortality, and lower admission rate than did patients with non-occupational injuries. Injury severity was associated with the time of injury, collision with other living objects, alcohol consumption, and helmet usage.
MeSH term(s)	Humans ; Motorcycles ; Retrospective Studies ; Accidents, Traffic ; Incidence ; Occupational Injuries/epidemiology ; Republic of Korea/epidemiology
Language	English
Publishing date	2023-03-29
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0283512
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Article: Lethal abdominal compartment syndrome after extracorporeal cardiopulmonary resuscitation in a patient with out-of-hospital cardiac arrest: a case report.

Kim, Gun Jik / Lim, Kyoung Hoon / Oh, Tak-Hyuk / Lee, Hyun-Joo / Hwang, Deokbi / Jung, Hanna

International journal of emergency medicine

2023 Volume 16, Issue 1, Page(s) 61

Abstract: Background: Clinical attempts of extracorporeal cardiopulmonary resuscitation (ECPR) in patients with out-of-hospital cardiac arrest (OHCA) have increased in recent years; however, it also has life-threatening complications. Massive fluid and ... ...

Abstract	Background: Clinical attempts of extracorporeal cardiopulmonary resuscitation (ECPR) in patients with out-of-hospital cardiac arrest (OHCA) have increased in recent years; however, it also has life-threatening complications. Massive fluid and transfusion resuscitation, shock status, or low cardiac output status during ECPR may lead to ascites and interstitial edema, resulting in secondary abdominal compartment syndrome (ACS). Case presentation: A 43-year-old male patient was admitted to the emergency department due to cardiac arrest. Due to refractory ventricular fibrillation, ECPR was initiated. Approximately, 3 h after extracorporeal membrane oxygenation support, abdominal distension and rigidity developed. Therefore, ACS was suspected. Decompression laparotomy was required to relieve elevated intra-abdominal pressure. Conclusions: We report a case of a patient with OHCA who developed lethal ACS after ECPR. Despite this, the patient was able to recover from several major crises. Regardless of how lethal the patient is, if compartment syndrome develops in any part of the body, we should aggressively consider surgical decompression.
Language	English
Publishing date	2023-09-26
Publishing country	England
Document type	Journal Article
ZDB-ID	2411462-5
ISSN	1865-1380 ; 1865-1372
ISSN (online)	1865-1380
ISSN	1865-1372
DOI	10.1186/s12245-023-00543-8
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Article ; Online: Impact of COVID-19 pandemic on interhospital transfer of patients with major trauma in Korea: a retrospective cohort study.

Cho, Sung Hoon / Nho, Woo Young / Lee, Dong Eun / Ahn, Jae Yun / Kim, Joon-Woo / Lim, Kyoung Hoon / Ryoo, Hyun Wook / Kim, Jong Kun

BMC emergency medicine

2024 Volume 24, Issue 1, Page(s) 53

Abstract: Background: Interhospital transfer (IHT) is necessary for providing ultimate care in the current emergency care system, particularly for patients with severe trauma. However, studies on IHT during the pandemic were limited. Furthermore, evidence on the ... ...

Abstract	Background: Interhospital transfer (IHT) is necessary for providing ultimate care in the current emergency care system, particularly for patients with severe trauma. However, studies on IHT during the pandemic were limited. Furthermore, evidence on the effects of the coronavirus disease 2019 (COVID-19) pandemic on IHT among patients with major trauma was lacking. Method: This retrospective cohort study was conducted in an urban trauma center (TC) of a tertiary academic affiliated hospital in Daegu, Korea. The COVID-19 period was defined as from February 1, 2020 to January 31, 2021, whereas the pre-COVID-19 period was defined as the same duration of preceding span. Clinical data collected in each period were compared. We hypothesized that the COVID-19 pandemic negatively impacted IHT. Results: A total of 2,100 individual patients were included for analysis. During the pandemic, the total number of IHTs decreased from 1,317 to 783 (- 40.5%). Patients were younger (median age, 63 [45-77] vs. 61[44-74] years, p = 0.038), and occupational injury was significantly higher during the pandemic (11.6% vs. 15.7%, p = 0.025). The trauma team activation (TTA) ratio was higher during the pandemic both on major trauma (57.3% vs. 69.6%, p = 0.006) and the total patient cohort (22.2% vs. 30.5%, p < 0.001). In the COVID-19 period, duration from incidence to the TC was longer (218 [158-480] vs. 263[180-674] minutes, p = 0.021), and secondary transfer was lower (2.5% vs. 0.0%, p = 0.025). Conclusion: We observed that the total number of IHTs to the TC was reduced during the COVID-19 pandemic. Overall, TTA was more frequent, particularly among patients with major trauma. Patients with severe injury experienced longer duration from incident to the TC and lesser secondary transfer from the TC during the COVID-19 pandemic.
MeSH term(s)	Humans ; Middle Aged ; Pandemics ; Retrospective Studies ; Patient Transfer ; COVID-19/epidemiology ; Trauma Centers ; Republic of Korea/epidemiology
Language	English
Publishing date	2024-04-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2050431-7
ISSN	1471-227X ; 1471-227X
ISSN (online)	1471-227X
ISSN	1471-227X
DOI	10.1186/s12873-024-00963-6
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Article ; Online: Blunt traumatic diaphragmatic rupture: Single-center experience with 38 patients.

Lim, Kyoung Hoon / Park, Jinyoung

Medicine

2018 Volume 97, Issue 41, Page(s) e12849

Abstract: Blunt traumatic diaphragmatic rupture (BTDR) is uncommon, but is associated with high rates of morbidity and mortality. The purpose of this study was to present our experience with management of this injury. Medical records of 38 patients with BTDR who ... ...

Abstract	Blunt traumatic diaphragmatic rupture (BTDR) is uncommon, but is associated with high rates of morbidity and mortality. The purpose of this study was to present our experience with management of this injury. Medical records of 38 patients with BTDR who were treated in our hospital from January 2001 to June 2016 were analyzed retrospectively. The sex, age, cause of injury, location of rupture, mode of diagnosis, time to diagnosis, the presence of herniation and bowel perforation, the presence of preoperative shock and intubation, Injury Severity Score (ISS), associated injuries, comorbidity, the operative procedure, morbidity and mortality, and the predictive factors affecting the outcome of BTDR were evaluated. There were 32 men (84.2%) and 6 women (15.8%) with a mean age of 51.2 years (range 18-84 years). The diagnosis could be preoperatively established in 28 patients (73.7%) with a plain chest X-ray or computed tomography scan. Rupture of diaphragm was left-sided in 31 patients (81.6%), right-sided in 6 (15.8%), and bilateral in 1 (2.6%). Sixteen patients had preoperative shock (systolic blood pressure <90 mm Hg, heart rate >120/min). Initial operative approaches were laparotomy in 22 patients (57.9%) and thoracotomy in 16 (42.1%). Eleven required additional exploration. The rate of additional exploration was higher in patients who initially underwent thoracotomy than laparotomy (56.2% vs 9.1%, P = .003). Patients who underwent additional exploration had a significantly longer operation time (330 minutes vs 237.5 minutes, P = .012), and a significantly higher morbidity rate (72.7% vs 22.2%, P =.008). Overall mortality was observed in 6 patients (15.8%). The mortality was associated with right-sided TDR (P = .042) and preoperative shock (P = .003). Neither ISS nor delay in diagnosis posed a statistically significant risk to the outcome of patients. Intra-abdominal organ injuries are more common than intrathoracic injuries in patients with BTDR, indicating that laparotomy should be the initial approach in these patients. Preoperative shock and right-sided TDR are predictive of mortality after BTDR.
MeSH term(s)	Abdominal Injuries/mortality ; Abdominal Injuries/pathology ; Abdominal Injuries/surgery ; Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Comorbidity ; Diaphragm ; Female ; Humans ; Injury Severity Score ; Laparotomy/methods ; Male ; Middle Aged ; Retrospective Studies ; Rupture/mortality ; Rupture/pathology ; Rupture/surgery ; Sex Factors ; Shock/epidemiology ; Thoracotomy/methods ; Time-to-Treatment ; Wounds, Nonpenetrating/mortality ; Wounds, Nonpenetrating/pathology ; Wounds, Nonpenetrating/surgery ; Young Adult
Language	English
Publishing date	2018-09-12
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000012849
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Article ; Online: Successful conservative treatment of acute traumatic occlusions of the celiac artery and superior mesenteric artery: A case report emphasizing the importance of the visceral collateral circulations.

Lim, Kyoung Hoon / Park, Jinyoung

Medicine

2018 Volume 97, Issue 46, Page(s) e13270

Abstract: Rationale: Blunt injury of major visceral arteries such as celiac artery (CA) and superior mesenteric artery (SMA) are very rare but fatal, therefore, these injuries are challenging to trauma surgeons. The patient with occlusion of CA or SMA is ... ...

Abstract	Rationale: Blunt injury of major visceral arteries such as celiac artery (CA) and superior mesenteric artery (SMA) are very rare but fatal, therefore, these injuries are challenging to trauma surgeons. The patient with occlusion of CA or SMA is theoretically viable by visceral collateral circulation. However, there are very rare cases in clinics. To date, there have been few reports of both CA and SMA occlusions after blunt trauma. Herein we describe our successful conservative treatment of patients with both CA and SMA occlusions. Patient concerns: Fifteen-year-old girl suffering from schizophrenia was transferred to our hospital after a fall from 3-floor-height with a purpose of suicide. Diagnoses: An abdominal computed tomography (CT) scan with contrast enhancement showed proximal CA and proximal SMA occlusions with surrounding retroperitoneal hematoma, however, distal parts of occlusion were supplied by the collateral vessels (enlarged marginal artery of left colon from inferior mesenteric artery and pancreaticoduodenal arcade). Interventions: She was treated by only supportive care without anticoagulant due to retroperitoneal hematoma. Outcomes: The patient was discharged 25 days after admission without complications. Lessons: We think that our patient could survive because her vascular status was healthy and collateral circulations were plenty according to the young age. We believe that this case can provide a basis for ligation in these forbidding and handless major visceral arterial injuries such as CA or SMA.
MeSH term(s)	Accidental Falls ; Adolescent ; Arterial Occlusive Diseases/etiology ; Arterial Occlusive Diseases/therapy ; Celiac Artery/injuries ; Conservative Treatment/methods ; Female ; Humans ; Mesenteric Artery, Superior/injuries ; Schizophrenia/complications ; Schizophrenic Psychology ; Suicide, Attempted/psychology ; Wounds, Nonpenetrating/therapy
Language	English
Publishing date	2018-12-01
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000013270
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