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Lee EJ, Park H, Kyoung KH, Park SJ. Transection of the Common Carotid and Vertebral Arteries Following a Penetrating Neck Injury. JOURNAL OF ACUTE CARE SURGERY 2021. [DOI: 10.17479/jacs.2021.11.3.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A case of a 30-year-old man who was admitted following a penetrating neck injury is presented. A clinical examination and operative findings identified semi-comatose mentality, neck muscle laceration, and transection of the left common carotid and vertebral arteries and the internal jugular vein. During the operation, the carotid arteries were repaired by interposition grafting, and the internal jugular vein was ligated. The vertebral artery was managed by interventional embolization. Although the patient had some neurological deficit, he was discharged on postoperative Day 52. This surgical case prompted a discussion regarding neurological outcomes, and surgical and endovascular treatment following vascular neck injury.
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Chung BH, Lee MR, Yang JD, Yu HC, Hong YT, Hwang HP. Delayed pseudoaneurysm formation of the carotid artery following the oral cavity injury in a child: A case report. World J Clin Cases 2021; 9:4104-4109. [PMID: 34141772 PMCID: PMC8180207 DOI: 10.12998/wjcc.v9.i16.4104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/15/2021] [Accepted: 04/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND An impalement injury of the oral cavity is a common traumatic injury in children. In most cases, it is not accompanied by sequelae, but if foreign body residues are not found due to a minor injury, they may result in inflammatory responses and delayed vascular injuries in the surrounding tissues. Without early diagnosis and appropriate initial management, residual foreign bodies can cause serious complications and even mortality in some cases.
CASE SUMMARY A 9-year-old boy suffered an intra-oral injury by a wooden chopstick, and the patient was discharged from the hospital after receiving conservative treatment for the injury. However, the patient was readmitted to the hospital due to intra-oral bleeding, and since neck hematoma and right internal carotid artery pseudoaneurysm formation were detected on computed tomography, emergency surgery was performed. A remnant fragment of a wooden chopstick was found during the operation, and a delayed rupture of the internal carotid artery caused by the foreign body was also found.
CONCLUSION The failure of early detection and diagnosis of a residual foreign body may result in delayed vascular rupture.
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Affiliation(s)
- Byeoung Hoon Chung
- Department ofSurgery, Jeonbuk National University Hospital, Jeonju 54907, South Korea
- Research Institute of Clinical Medicine, Jeonbuk National University, Jeonju 54907, South Korea
- Biomedical Research Institute, Jeonbuk University Hospital, Jeonju 54907, South Korea
| | - Mi Rin Lee
- Department ofSurgery, Jeonbuk National University Hospital, Jeonju 54907, South Korea
- Research Institute of Clinical Medicine, Jeonbuk National University, Jeonju 54907, South Korea
- Biomedical Research Institute, Jeonbuk University Hospital, Jeonju 54907, South Korea
| | - Jae Do Yang
- Department ofSurgery, Jeonbuk National University Hospital, Jeonju 54907, South Korea
- Research Institute of Clinical Medicine, Jeonbuk National University, Jeonju 54907, South Korea
- Biomedical Research Institute, Jeonbuk University Hospital, Jeonju 54907, South Korea
| | - Hee Chul Yu
- Department ofSurgery, Jeonbuk National University Hospital, Jeonju 54907, South Korea
- Research Institute of Clinical Medicine, Jeonbuk National University, Jeonju 54907, South Korea
- Biomedical Research Institute, Jeonbuk University Hospital, Jeonju 54907, South Korea
| | - Yong Tae Hong
- Research Institute of Clinical Medicine, Jeonbuk National University, Jeonju 54907, South Korea
- Biomedical Research Institute, Jeonbuk University Hospital, Jeonju 54907, South Korea
- Department ofOtolaryngology-Head-Neck-Surgery, Jeonbuk National University Hospital, Jeonju 54907, South Korea
| | - Hong Pil Hwang
- Department ofSurgery, Jeonbuk National University Hospital, Jeonju 54907, South Korea
- Research Institute of Clinical Medicine, Jeonbuk National University, Jeonju 54907, South Korea
- Biomedical Research Institute, Jeonbuk University Hospital, Jeonju 54907, South Korea
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Rattan A, Kataria R, Kumar A, Azam Q. Blunt carotid injury with thrombotic occlusion: Is an intervention always required for best outcome? Trauma Case Rep 2019; 24:100263. [PMID: 31872027 PMCID: PMC6911937 DOI: 10.1016/j.tcr.2019.100263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2019] [Indexed: 01/26/2023] Open
Abstract
Blunt cerebrovascular injuries are rare, comprises of 0.08 to 0.33% of all traumatic blunt injuries. Depending on the grade of severity, they may heal with minimal consequences or may lead to debilitating and devastating stroke. Surgically accessible lesions are infrequent and hence endovascular management is preferred modality for high-grade lesions. We hereby present a case of complete thrombosis of the common carotid artery, which couldn't receive either surgical or endovascular treatment due to low resource settings. The patient developed a stroke after 18 h of trauma, which, however, recovered completely and dramatically within 96 h. To the best of our knowledge, such rapid and complete recovery from stroke secondary to blunt carotid injury managed non-operatively hasn't been reported in literature so far. Our report adds to the scarce but growing body of evidence recommending conservative management in BCVI in absence of enlarging pseudoaneurysm and dissection with near-complete stenosis.
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Affiliation(s)
- Amulya Rattan
- Department of Trauma Surgery & Critical Care, Trauma Center, AIIMS Rishikesh, India
| | - Ruby Kataria
- Department of Trauma Surgery & Critical Care, Trauma Center, AIIMS Rishikesh, India
| | - Ajay Kumar
- Department of Trauma Surgery & Critical Care, Trauma Center, AIIMS Rishikesh, India
| | - Quamar Azam
- Department of Trauma Surgery & Critical Care, Trauma Center, AIIMS Rishikesh, India
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Pereira BMT, Chiara O, Ramponi F, Weber DG, Cimbanassi S, De Simone B, Musicki K, Meirelles GV, Catena F, Ansaloni L, Coccolini F, Sartelli M, Di Saverio S, Bendinelli C, Fraga GP. WSES position paper on vascular emergency surgery. World J Emerg Surg 2015; 10:49. [PMID: 26500690 PMCID: PMC4618918 DOI: 10.1186/s13017-015-0037-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 02/24/2015] [Indexed: 12/18/2022] Open
Abstract
Trauma, both blunt and penetrating, is extremely common worldwide, as trauma to major vessels. The management of these patients requires specialized surgical skills and techniques of the trauma surgeon. Furthermore few other surgical emergencies require immediate diagnosis and treatment like a ruptured abdominal aortic aneurysm (rAAA). Mortality of patients with a rAAA reaches 85 %, with more than half dying before reaching the hospital. These are acute events demanding immediate intervention to save life and limb and precluding any attempt at transfer or referral. It is the purpose of this position paper to discuss neck, chest, extremities and abdominal trauma, bringing to light recent evidence based data as well as expert opinions; besides, in this paper we present a review of the recent literature on rAAA and we discuss the rationale for transfer to referral center, the role of preoperative imaging and the pros and cons of Endoluminal repair of rAAA (REVAR) versus Open Repair (OR).
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Affiliation(s)
- Bruno Monteiro T. Pereira
- />Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | | | - Fabio Ramponi
- />Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW Australia
| | - Dieter G. Weber
- />Department of Traumatology, John Hunter Hospital, Newcastle, NSW Australia
| | | | - Belinda De Simone
- />Department of Emergency and Trauma Surgery of the University Hospital of Parma, Parma, Italy
| | - Korana Musicki
- />Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW Australia
| | - Guilherme Vieira Meirelles
- />Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | - Fausto Catena
- />Department of Emergency and Trauma Surgery of the University Hospital of Parma, Parma, Italy
| | - Luca Ansaloni
- />Department of general and emergency surgery, Papa Giovanni XIII Hospital, Bergamo, Italy
| | - Federico Coccolini
- />Department of general and emergency surgery, Papa Giovanni XIII Hospital, Bergamo, Italy
| | | | | | - Cino Bendinelli
- />Department of Traumatology, John Hunter Hospital, Newcastle, NSW Australia
| | - Gustavo Pereira Fraga
- />Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
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Cuellar TA, Lottenberg L, Moore FA. Blunt cerebrovascular injury in rugby and other contact sports: case report and review of the literature. World J Emerg Surg 2014; 9:36. [PMID: 24872841 PMCID: PMC4036724 DOI: 10.1186/1749-7922-9-36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 04/15/2014] [Indexed: 11/10/2022] Open
Abstract
Contact sports have long been a part of human existence. The two earliest recorded organized contact games, both of which still exist, include Royal Shrovetide Football played since the 12(th) century in England and Caid played since 1308 AD in Ireland. Rugby is the premier contact sport played throughout the world with the very popular derivative American football being the premier contact sport of the North American continent. American football in the USA has on average 1,205,037 players at the high school and collegiate level per year while rugby in the USA boasts a playing enrollment of 457,983 at all levels. Recent media have highlighted injury in the context of competitive contact sports including their long-term sequelae such as chronic traumatic encephalopathy (CTE) that had previously been underappreciated. Blunt cerebrovascular injury (BCVI) has become a recognized injury pattern for trauma; however, a paucity of data regarding this injury can be found in the sports trauma literature. We present a case of an international level scrum-half playing Rugby Union at club level for a local non-professional team, in which a player sustained a fatal BCVI followed by a discussion of the literature surrounding sport related BCVI.
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Affiliation(s)
- Trajan A Cuellar
- Division of Acute Care Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Lawrence Lottenberg
- Division of Acute Care Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Frederick A Moore
- Division of Acute Care Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
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Lichtenfels E, Cardozo MA, Erling Jr. N, Aerts NR. Endovascular treatment of iatrogenic penetrating trauma of the carotid artery: case report. J Vasc Bras 2014. [DOI: 10.1590/jvb.2014.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Carotid trauma demands early diagnosis and treatment. Open repair may be technically challenging if the trauma is at the base of the neck. We present a case of iatrogenic penetrating carotid trauma caused by insertion of a hemodialysis catheter. Treatment was accomplished by placement of a covered stent-graft in the common carotid artery, covering the puncture site. This case suggests that placement of a covered stent-graft is a good option for treatment of iatrogenic injury to the carotid artery.
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Affiliation(s)
- Eduardo Lichtenfels
- Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA, Brazil; Irmandade Santa Casa de Misericórdia de Porto Alegre - ISCMPA, Brazil
| | | | - Nilon Erling Jr.
- Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA, Brazil; Irmandade Santa Casa de Misericórdia de Porto Alegre - ISCMPA, Brazil
| | - Newton Roesch Aerts
- Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA, Brazil; Irmandade Santa Casa de Misericórdia de Porto Alegre - ISCMPA, Brazil
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Luo Y, Yuan H, Cao ZS. Residual foreign body in the neck after trauma results in the delayed rupture of the common carotid and internal jugular vein: a case report. J Med Case Rep 2013; 7:13. [PMID: 23305419 PMCID: PMC3558450 DOI: 10.1186/1752-1947-7-13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 11/07/2012] [Indexed: 02/06/2023] Open
Abstract
UNLABELLED INTRODUCTION Trauma and foreign body residue occurring in different settings are common in the neck. Some small injuries go unrecognized, and vascular injuries caused by the sharp penetrating trauma of a foreign body are very dangerous. Without early diagnosis and treatment, foreign body residue remains a major cause of mortality. CASE PRESENTATION A six-cm piece of wooden chopstick was not initially detected in the neck of a 24-year-old Chinese man presenting with a slight bleeding wound after a brawl accident. Three days later, the patient had an expanding neck hematoma and shortness of breath. Computed tomography revealed a dense shadow in the soft tissue of the left side of the patient's neck, and surgical exploration found that a residual broken chopstick had resulted in a delayed rupture of the common carotid artery and internal jugular vein. CONCLUSION A residual foreign body should be seriously considered after neck trauma because it can result in a lethal hemorrhage originating from a delayed rupture of blood vessels.
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Affiliation(s)
- Yan Luo
- Department of Otorhinolaryngology, The Second Affiliated Hospital of Soochow University, Soochow, Jiangsu Province, China.
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Agid R, Simons M, Casaubon LK, Sniderman K. Salvage of the carotid artery with covered stent after perforation with dialysis sheath. A case report. Interv Neuroradiol 2012; 18:386-90. [PMID: 23217633 DOI: 10.1177/159101991201800404] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 08/12/2012] [Indexed: 11/15/2022] Open
Abstract
We present a rare case of carotid tear caused by iatrogenic erroneous insertion of a dialysis sheath into the common carotid artery (CCA). This was treated by placement of a covered stent-graft in the CCA over the puncture site. This treatment achieved hemostasis while preserving the carotid artery with good outcome. The technical details are presented and the relevant literature regarding treatment of carotid blowout syndrome is discussed. This case suggests that placement of a covered stent-graft is a good option not only for the "usual" blowout syndrome due to head and neck tumors, but also for treatment of iatrogenic injury to the carotid artery.
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Affiliation(s)
- R Agid
- Department of Medical Imaging, Divisions of Neuroradiology, Toronto Western Hospital, University Health Network, Ontario, Canada.
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Abstract
Delayed sequelae after pressure on the neck are rare. Awareness of such sequelae as well as a high degree of suspicion is essential for early detection and proper clinical management. Injuries to the common carotid artery and pseudo aneurysm formation leading to fatal hemorrhage are still rare occurrences after attempts of manual strangulation. When such cases are presented to the forensic pathologist, he has to establish the link between the cause and effect, excluding other possible causes for such complications. In addition, he may have to give opinions in possible medical negligence charges.
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Life-threatening carotid haemorrhage following blunt trauma. The Journal of Laryngology & Otology 2009; 124:1030-2. [PMID: 20025814 DOI: 10.1017/s0022215109992465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION We report a case of internal carotid arterial damage following blunt neck trauma. This rare mechanism of injury demands a high index of suspicion to enable prompt specialist management. CASE REPORT A 22-year-old man presented to hospital after sustaining blunt neck trauma. Rapid onset of stridor necessitated an emergency tracheostomy. Computed tomography angiography demonstrated a tear of the right internal carotid artery, which was repaired surgically. DISCUSSION Blunt carotid vessel injury, although rare, has a high mortality rate. Mechanisms of injury include hyperextension and contralateral neck rotation, a direct blow to the vessel, and laceration by adjacent bony structures. The 'gold standard' investigation for suspected blunt carotid vessel injury is catheter angiography, although this carries a small risk of stroke. Computed tomography angiography is a less invasive, alternative investigation which has almost equivalent accuracy. The extent of damage to the vessel wall will dictate treatment. In our literature review, we discuss the presentation, investigation and different treatment modalities available. CONCLUSION This case highlights an unusual mechanism of carotid artery injury, with a delayed, potentially fatal presentation. Such injury demands a high index of suspicion, and confirmation with specific investigations. Management is hazardous and requires experienced personnel in all aspects of care.
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