Case Reports in Emergency Surgery and Trauma

Beyond breathless: a case of air infiltrating every cavity

Motohisa Tsuruta — 2024-09-16

Hawaii attracts 10 million tourists annually, with non-residents accounting for 9% of trauma cases, half of which are water-related. We experienced a SCUBA tank injury, causing extensive trauma from pressurized air release. A 53-year-old female, post-Scuba diving, fell onto a SCUBA tank, causing rapid pressurized air discharge. She presented with perineal pain, bloating, and extensive subcutaneous emphysema. CT revealed air in every possible cavity. Thoracostomies and exploratory laparotomy performed, revealing an 80-90% anal sphincter transection. An overlapping anal sphincteroplasty with diverting loop ileostomy was performed. Recovery was uncomplicated. This unique case involves a traumatic SCUBA tank air release causing extensive damage. The patient avoided direct anorectal entry, preventing catastrophic damage but sustained an anal sphincter complex injury. Air likely entered the peritoneum through the levator ani, causing pneumoperitoneum and pneumothoracies. The extensive damage emphasizes the need for safe water sports practices. The patient’s recovery highlights the human body’s resilience in unique situations.

Traumatic carotid artery dissection in polytrauma: is conservative treatment an adequate strategy? A case report

Filippo Grandini — 2024-06-12

We present the case of a 24-year-old man, involved in a car accident, with a traumatic right carotid artery dissection Grade II Blunt CerebroVascular Injury (BCVI) according to the Eastern Association for the Surgery of Trauma (EAST). The patient arrived at our hospital without neurological symptoms and was then admitted to the Intensive Care Unit (ICU) for neurological monitoring; antithrombotic and antiplatelet therapy was initiated and in line with current literature, no routine endovascular treatment was performed. Twenty-four hours post-trauma, the patient required an urgent abdominal surgical intervention under general anesthesia. Upon awakening, he presented with left hemiplegia. The CT scan revealed hypodensity in the front-insular region prompting an urgent endovascular procedure. Fourteen days post trauma the patient was discharged from the Stroke Unit with an unchanged neurological performance, despite receiving appropriate treatment for Grade II BCVI, as recommended in current literature. Our patient developed a severe neurological disability. Further discussions are needed.

Sneeze-induced transvaginal small bowel evisceration and obstruction nine months after iatrogenic vaginal vault laceration: a case report

Francesco Salvetti — 2024-02-06

Transvaginal evisceration (TE) is the extrusion of intra-abdominal viscera through the vagina. According to the literature, few cases have been reported, most of them involving elderly women who underwent previous pelvic surgery. Here we present the case of a 72-year-old woman who was admitted to our hospital due to the sensation of vaginal obstruction that appeared after a sneeze nine months after a repair of a vault laceration following prior complex pelvic surgery. A clinical diagnosis of small bowel transvaginal evisceration with obstruction was quickly made. In this case, adhesions, bowel obstruction, and the presence of a fibrotic scar on the vaginal vault were the main obstacles to the repair. However, a multidisciplinary evaluation and a combined laparoscopic-transvaginal minimally-invasive approach proved to be safe and effective in achieving good surgical outcomes in the treatment of this condition.

Catastrophic uterine rupture of an unscarred uterus following motor vehicle rollover – a case report

Rachel Tindal — 2024-09-09

A 22 year old female at 6 months gestation with no history of prior abdominal surgery or previous uterine procedures presented via air transport after highway motor vehicle rollover. Due to hemodynamic instability, the only preoperative imaging that was able to be obtained was bedside sonography, which confirmed free fluid in the upper quadrants and unfortunately, fetal demise. In the operating room, source of bleeding was noted to be multiple large uterine ruptures. Uterine rupture in trauma in the absence of prior uterine surgery is a rare event and has never been reported in the third trimester, however it should remain in the differential for a pregnant trauma patient presenting with hemodynamic instability.