Matsumoto Naoya, Hayashi Nobuhiro, Morita Chika, Taguchi Yuji, Chan Minnie, Tagawa Yoshihiro, Sakahira Hideki, Takaoka Makoto
Steel Memorial Hirohata Hospital, Himeji Emergency, Trauma and Critical Care Center, 3-1, Yumesakicho Hirohata-ku, Himeji-shi, Hyogo 671-1122, Japan.
Steel Memorial Hirohata Hospital, Department of Surgery, 3-1, Yumesakicho Hirohata-ku, Himeji-shi, Hyogo 671-1122, Japan.
Trauma Case Rep. 2022 May 25;40:100658. doi: 10.1016/j.tcr.2022.100658. eCollection 2022 Aug.
Rib fractures can cause injury to some organs. We herein report a case of hemorrhagic shock due to intercostal artery injury that occurred during initial trauma care (ITC) treated by resuscitative thoracotomy (RT) and transcatheter arterial embolization (TAE) with multiple displaced rib fractures (RFs) and traumatic head injury (THI). A man in his 50s who was injured in a traffic accident was transferred to our institution by helicopter for emergency medical treatment. He underwent left thoracic drainage on site. On admission, he was diagnosed with multiple RF, THI, pelvic fracture and right humerus fracture. His D-dimer and fibrin degradation products (FDP) level were extremely elevated. However, contrast enhance CT (CECT) revealed no extravasation. At 2 h after arrival, massive hemorrhaging from his thoracic tube suddenly occurred and his blood pressure decreased to approximately 40s mmHg. CECT performed after volume resuscitation and massive transfusion revealed extravasation from the intercostal artery. Because his blood pressure could not be maintained by massive transfusion, we performed RT and TAE followed by RT. He then received intensive care and several surgical procedures were performed, including craniotomy for removal of hematoma, rib fixation and humerus fixation. He was transferred to another hospital for rehabilitation on day 63, with a GCS of 15. Hemorrhagic shock due to intercostal artery injury may occur at any time from arrival in cases with displaced RF, especially when complicated by THI.
肋骨骨折可导致一些器官损伤。我们在此报告一例因肋间动脉损伤导致的失血性休克病例，该病例发生在初始创伤治疗（ITC）期间，通过复苏性开胸手术（RT）和经导管动脉栓塞术（TAE）进行治疗，患者存在多处移位肋骨骨折（RFs）和创伤性脑损伤（THI）。一名50多岁的男性在交通事故中受伤，由直升机转运至我院进行紧急治疗。他在现场接受了左胸引流。入院时，他被诊断为多处RF、THI、骨盆骨折和右肱骨骨折。他的D-二聚体和纤维蛋白降解产物（FDP）水平极度升高。然而，增强CT（CECT）未显示造影剂外渗。到达后2小时，他的胸腔引流管突然大量出血，血压降至约40s mmHg。在容量复苏和大量输血后进行的CECT显示肋间动脉有造影剂外渗。由于大量输血无法维持他的血压，我们先进行了RT和TAE，随后又进行了RT。然后他接受了重症监护，并进行了多项外科手术，包括开颅血肿清除术、肋骨固定术和肱骨固定术。他在第63天被转至另一家医院进行康复治疗，格拉斯哥昏迷量表（GCS）评分为15分。对于存在移位RF的病例，尤其是合并THI时，肋间动脉损伤导致的失血性休克可能在到达后的任何时间发生。
