Background: The neck is a particularly critical region to sustain penetrating injuries, due to the close approximation of the trachea, esophagus, blood vessels, and the spinal cord. A penetrating neck injury has the potential for serious morbidity and mortality. The purpose of this study is to evaluate the assessment and management of penetrating neck injuries.Methods: In this retrospective study, penetrating neck injury patients who were admitted to Eulji University Hospital Trauma Center, between December 2015 and December 2017, were analyzed for epidemiology, mechanism of trauma, injured organ, complications, and mortality.Results: Thirty-two patients presented with a penetrating neck injury. All patients underwent computed tomographic angiography to evaluate their injuries once vital signs were stabilized.Among these patients, 27 required surgical treatment. The most commonly injured organ was the trachea. Overall mortality was five, and the main cause of death was bleeding. The mortality was associated with initial systolic blood pressure at the hospital, Glasgow coma scale, transfusion and the abbreviated injury scale of neck.Conclusion: Meticulous clinical examination as well as early volume resuscitation is essential for treating penetrating neck injury patients. Aggressive fluid therapy during transfer to the hospital will help the patient, even if the damage is severe.
Percutaneous dilatational tracheostomy (PDT) is preferred over conventional surgical tracheostomy for prolonged airway protection and mechanical ventilation. However, despite its advantages, severe PDT-related complications have been reported, including catastrophic hemorrhage from common carotid artery laceration and innominate artery pseudo-aneurysm. PDT can typically be applied to the trachea, which is the focal point for the transverse course of great vessels (e.g., the anomalous brachiocephalic trunk, which overlaps with the targeted lesion anteriorly); therefore, to improve patient outcomes, an alternative method using aortic debranching may be considered.
A 33-year-old man who had undergone bypass from the distal aortic arch to the proximal descending thoracic aorta with a Dacron graft to treat coarctation of the aorta 20 years prior presented to the emergency department with massive hemoptysis. He was diagnosed with a graft-to-bronchial fistula. After thoracic endovascular aneurysm repair through the coarctation, aortic replacement was performed 3 weeks later. Therefore, emergency-rescue thoracic endovascular aneurysm repair can be considered for preventing aortic rupture.
A 68-year-old male patient with a history of femoro-femoral bypass following unsuccessful intervention for chronic total iliac occlusion was found to have a saccular pseudoaneurysm of the right common iliac artery (CIA) due to interventional device-related injuries associated with the past endovascular intervention. An iatrogenic pseudoaneurysm in the CIA is generally asymptomatic, but it has a high risk of rupture, regardless of its size or symptoms. Endovascular therapy may be the best treatment option; however, ineffective sealing with a stent graft may lead to a type I endoleak. Under such conditions, use of the liquid embolic agent, Onyx, as a bailout solution for the type 1 endoleak is promising.
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