Hydrodynamic rupture of liver in combat patient: a case of successful application of “damage control” tactic in area of the hybrid war in East Ukraine

Tsema

Shklyarevych³

et al. 2018

J Med Case Reports

Self Cite

BackgroundPulmonary artery embolization due to projectile embolus is a rare complication in combat patients. Such embolization is rare for combat patients in the ongoing armed conflict, in East Ukraine since 2014.Case presentationWe report a clinical case of a 34-year-old Caucasian combat patient who was injured after an explosion of a booby trap hand grenade. This soldier was diagnosed with severe abdominal and skeletal trauma: damage of the duodenum and transverse colon, internal bleeding due to inferior vena cava damage and fractures of both lower extremities. The patient was treated at a highly specialized surgical center within the “golden hour” time. Whole-body computed tomography scan was performed as a routine screening method for hemodynamically stable patients, at which we identified a projectile embolus due to the explosion of a booby trap hand grenade in the right midlobar pulmonary artery. Our patient had no clinical manifestation of pulmonary artery embolism. At follow-up, our patient was diagnosed with the following complications: multiple necrosis and perforations of the transverse colon leading to a fecal peritonitis; duodenum suture line leakage caused the formation of a duodenal fistula; postoperative wound infection. These complications required multiple secondary operations, and in accordance to the principles of damage-control tactics, the extraction of projectile-embolus was postponed. Open surgery retrieval of the metal fragment was successfully performed on the 80th day after injury. Our patient was discharged from the hospital on day 168th after injury.ConclusionsLiterature analysis shows a significant difference of clinical management for patient with projectile embolism in hybrid war settings as compared to previously described cases of combat and civil gunshot injuries. Damage control tactics and the concept of the “golden hour” are highly effective for those injured in a hybrid war.A whole-body computed tomography scan is an effective screening method for asymptomatic patients with projectile-embolism of the great vessels.The investigation of a greater cohort of combat patients with severe injuries and projectile-embolism should be performed in order to develop a better guideline for these patients and to save more lives.

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pulmonary artery embolism by a metal fragment after a booby trap explosion in a combat patient injured in the armed conflict in East Ukraine: a case report and review of the literature

Tsema

Shklyarevych³

et al. 2018

J Med Case Reports

Self Cite

“…Матеріали та методи. Вибір методу та часу проведення оперативного втручання залишається складною проблемою для хірургів другого рівня надання медичної допомоги, що надає підґрунтя для реалізації нових методів діагностики та моніторингу при лікуванні поранених [11,12,13].…”

Section: (48) June 2020 Rs Globalunclassified

“…Кількість вогнепальних поранень кінцівок складає від 52-70 %, а в деяких випадках і до 80% від загальної кількості поранених [4,9,5,12]. З яких 35-40% -це поранені з відкритими вогнепальними переломами кісток та 19-30% -поранення м'яких тканин різного ступеню важкості [3,8,10,11].…”

unclassified

The First Stage Reconstruction of the Soft Tissue Defects of Gunshot Wounds

RS Global - Web of Scholar

Гуменюк²,

Tsema³

et al. 2020

The aim. To investigate and used a multimodal diagnostic scheme during the first stage of reconstructive surgical treatment of wounded with soft tissue defects at the second level of medical care.Materials and methods. By identifying thermographic areas with gunshot wounds of the soft tissues, we observed at the second level of medical care during 4 months of 2020 (from March to July) 37 cases.Results. We used a multimodal scheme in the pre-, intra- and postoperative period helps to reduce the area of defects in 23 (62.2%) cases out of 37 against the background of restoration and preservation of microcirculation in the damaged structure, and the number of subjectively unsatisfactory military personnel in 4 (12.8%) of the total the number of wounded, a decrease in the loss of functional ability in 19 (51.2%) cases.Conclusions. The combination of dynamic digital thermography in combination with an audio doppler at the second level of medical care can improve the quality of primary surgical treatment by performing surgery with clear indications of the proposed technique; maintain a larger volume of viable tissues, reduce the area of the defect and the number of complications in the further treatment of the wounded.

Application of Damage Control Tactics and Transpapillary Biliary Decompression for Organ-Preserving Surgical Management of Liver Injury in Combat Patient

Tsema

Humeniuk³

et al. 2021

Military Medicine

The combat penetrating gunshot injury is frequently associated with damage to the liver. Bile leak and external biliary fistula (EBF) are common complications. Biliary decompression is commonly applied for the management of EBF. Also, little is known about the features of combat trauma and its management in ongoing hybrid warfare in East Ukraine. A 23-year-old male was diagnosed with thoracoabdominal penetrating gunshot wound (GSW) by a high-energy multiple metal projectile. Damage control tactics were applied at all four levels of military medical care. Biliary decompression was achieved by endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (EST) and the placement of biliary stents. Occlusion of the stent was treated by stent replacement, and scheduled ERCP was performed. Partial EBF was diagnosed from the main wound defect of the liver and closed without surgical interventions on the 34th day after the injury. A combination of operative and nonoperative techniques for the management of the combat GSW to the liver is effective along with the application of damage control tactics. A scheduled ERCP application is an effective approach for the management of EBF, and liver resection could be avoided. A successful biliary decompression was achieved by the transpapillary intervention with the installation of stents. Stent occlusion could be diagnosed in the early post-traumatic period, which is effectively managed by scheduled ERCP as well as stent replacement with a large diameter as close as possible to the place of bile leak.