Search

Abstract Background Anorectal injury caused by personal watercraft (PWC)‐related trauma is rare. However, PWC accidents have increased recently, and since patients tend to be younger, treatment strategies should consider anal function preservation in addition to saving lives. Case Presentation A 30‐year‐old female patient who fell into the water when a PWC suddenly accelerated and injured her perineum with a forceful water jet was transported to our hospital. On examination, she was diagnosed with a traumatic rectal perforation with intraperitoneal findings and an anorectal injury. Emergency surgery, which involved direct suturing, temporary colostomy with intraoperative endoscopy for the rectal perforation, and anorectal reconstruction, was performed. The patient was discharged on postoperative day 19 without complications, and the colostomy was closed 5 months postoperatively. Conclusion We encountered a case of multiple noncontinuous anorectal injuries due to a PWC accident that was successfully treated using a combination of surgery and intraoperative endoscopy.

Abstract Background As the prognosis of esophageal cancer surgery has improved, reports on postoperative complications of gastric tubes have increased. Among them, gastric tube ulcer perforation is infrequent but often severe and difficult to treat. Case Presentation A 73‐year‐old man had undergone thoracoscopic subtotal esophagectomy and laparoscopic‐assisted gastric tube reconstruction via the retrosternal route for thoracic esophageal cancer 8 years previously. He was transferred to our hospital with a diagnosis of gastric tube ulcer perforation, penetrating the pericardium. Emergency surgery was performed to remove the gastric tube, followed by immediate reconstruction by right colon interposition. The patient was discharged on postoperative day 142. Conclusion We report a rare complication of gastric tube ulcer perforation, penetrating the pericardium, after esophagectomy for esophageal cancer. It was successfully treated with appropriate surgical management.

Aim To compare in‐hospital mortality of severely injured trauma patients who underwent resuscitative endovascular balloon occlusion of the aorta (REBOA) or aortic cross‐clamping (ACC). Methods In this multicenter, retrospective cohort study using data from a nationwide trauma registry of tertiary emergency medical centers in Japan (n = 280), trauma patients who underwent aortic occlusion at the emergency department from 2004 to 2019 were divided into two groups according to the treatment they received: patients treated with ACC and patients who underwent placement of a REBOA catheter. Multiple imputations were used to handle the missing data. In‐hospital mortality of the patients who underwent REBOA or ACC was compared using a mixed‐effect logistic regression analysis and a propensity score‐matching analysis, in which the confounders, including baseline patient demographics and severity, were adjusted. Results Of 1,670 patients (1,137 with REBOA and 533 with ACC), 66% were male. The median age was 56 years, and the mortality rate was 55.2% in the REBOA group and 81.6% in the ACC group. The mixed‐effect model regression analysis showed a significantly lower odds ratio for in‐hospital mortality rate in the REBOA group (odds ratio 0.17; 95% confidence interval, 0.12–0.26). A similar odds ratio was observed in the propensity score matching analysis (odds ratio 0.27; 95% confidence interval, 0.18–0.40). Conclusion Compared with ACC, REBOA use was associated with decreased mortality in severely injured trauma patients.

Background A common iliac vein injury in the absence of pelvic fractures due to blunt trauma is rare, with no treatment strategy established. Case Presentation A 48‐year‐old man, who was injured in a dumbwaiter accident, presented to the hospital with hemorrhagic shock. Computed tomography (CT) revealed active bleeding from the intercostal and hepatic arteries as well as the left common iliac vein. No pelvic fracture was noted. Preperitoneal pelvic packing was performed for the left common iliac vein injury as a damage control surgery. After the operation, endovascular embolization was performed to address the arterial bleeding. The patient became hemodynamically stable, and follow‐up CT showed no signs of bleeding. The packing gauze was removed 3 days after the admission. The patient was discharged without complications. Conclusion Preperitoneal pelvic packing provided temporary hemostasis in a hemodynamically unstable patient with common iliac vein injury but with no pelvic fractures.

Background The management of pancreatic injury is not well‐established. Recently, endoscopic therapy has been reported as a treatment option for main pancreatic duct disruption. Case Presentation A 68‐year‐old man presented to our hospital and was diagnosed with severe traumatic pancreatic injury that developed 2 days prior. Endoscopic retrograde cholangiopancreatography revealed main pancreatic duct disruption. Although initial stenting to the distal main pancreatic duct was not achieved because of the widespread intermediate fluid collection, an endoscopic naso‐pancreatic drainage tube was successfully inserted into via the main duodenal papilla. After drainage, the endoscopic naso‐pancreatic drainage tube was replaced with an endoscopic retrograde pancreatic drainage tube, and a stent was successfully placed into the distal main pancreatic duct via the minor papilla. Conclusion We report a case of severe pancreatic injury managed using multi‐stage endoscopic therapy that could be a possible treatment strategy for pancreatic injury with total main pancreatic duct disruption.

Aim Patients with severe coronavirus disease 2019 (COVID‐19) pneumonia often have complications of coagulopathy and thrombotic phenomena, which lead to high mortality. Whether administering systematic anticoagulant therapy is beneficial remains unclear. We report our experience using systemic anticoagulation with unfractionated heparin to treat severe COVID‐19. Methods We conducted a retrospective historical control study of severe COVID‐19 patients requiring mechanical ventilation who received prophylactic‐dose anticoagulation (April 1–May 25) or therapeutic‐dose anticoagulation (May 26–August 31) in the intensive care unit (ICU) of a tertiary emergency critical care medical center in Japan. The primary endpoints were in‐hospital mortality and anticoagulation therapy‐related adverse events. The secondary endpoints included thromboembolic events, administration of venovenous extracorporeal membrane oxygenation (ECMO), ventilator‐free days (VFDs), ICU‐free days, and the development of multiple organ dysfunction syndrome. Results A total of 29 and 33 patients were in the prophylactic‐dose and therapeutic‐dose groups, respectively. Background characteristics between the groups were not significantly different, although the therapeutic‐dose group had a significantly lower in‐hospital mortality rate [5 (17.2%) patients versus 0 (0.0%) patients; P = 0.033] and longer ICU‐free days (median [interquartile range]: 15 days [13–18] versus 5 days [0–13]; P = 0.008). Hemorrhagic‐events did not occur during the study period. Compared with the prophylactic‐dose group, the therapeutic‐dose group tended to have longer VFDs, was not treated with ECMO, and did not experience thromboembolic events and multiple organ dysfunction syndrome; however, the difference was not statistically significant. Conclusions Therapeutic‐dose anticoagulation may be beneficial for patients with severe COVID‐19 pneumonia requiring mechanical ventilation.