Antiphospholipid syndrome with renal and splenic infarction after blunt trauma:A case report

BACKGROUND In trauma patients,bleeding is an immediate major concern.At the same time,there are few cases of acute vascular occlusion after blunt trauma,and it is unclear what assessment and diagnosis should be considered for these cases.Herein,we describe a patient diagnosed with antiphospholipid syndrome after a hypercoagulable workup for acute renal and splenic vascular occlusion due to blunt trauma.CASE SUMMARY A 20-year-old man was admitted to the emergency department with abdominal pain after hitting a tree while riding a sled 10 h ago.He had no medical history.Radiological investigations revealed occlusion of the left renal artery with global infarction of the left kidney and occlusion of branches of the splenic artery with infarction of the central portion of the spleen.Attempted revascularization of the left renal artery occlusion through percutaneous transluminal angioplasty failed due to difficulty in passing the wire through the total occlusion.Considering the presence of acute multivascular occlusions in a young man with low cardiovascular risk,additional laboratory tests were performed to evaluate hypercoagulability.The results suggested a high possibility of antiphospholipid syndrome.Treatment with a subcutaneous injection of enoxaparin was started and changed to oral warfarin after two weeks.The diagnosis was confirmed,and he continued to visit the rheumatology outpatient clinic while taking warfarin.CONCLUSION A hypercoagulable workup can be considered in trauma patients with acute multivascular occlusion,especially in young patients with low cardiovascular risk.

Emergency percutaneous thoracic endovascular aortic repair for patients with traumatic thoracic aortic blunt injury: A single center experience

Purpose:To analyze the efficacy and outcome of percutaneous thoracic endovascular aortic repair(TEVAR)in patients with traumatic blunt aortic injury in our single-center.Methods:From January 2014 to December 2018,a total of 89 patients with traumatic blunt aortic injuries were treated with emergency TEVAR in our center.Their clinical data such as demographics,operative details and postprocedure outcomes were analyzed retrospectively in this study using SPSS 20 software.Continuous variables were expressed as mean and standard deviation or median and interquartile range.Categorical variables are expressed as the numbers and percentages of patients.Results:The median age of the patients was 37 years,and 76(85.4%)were males.All the patients were involved in violent accidents and combined with associated injuries.Two patients died while awaiting the operations and 87 patients underwent emergency percutaneous TEVAR,with a 100%technique success.The mean time interval from admission to operating room was(90.1±18.7)min,and the mean procedure time was(54.6±11.9)min.Eighty(92.0%)patients were operated on under local anesthesia,while other 7(8.0%)patients were under general anesthesia.Two cases underwent open repair of the femoral arteries because of the pseudoaneurysm formation of the access vessels.A total of 98 aortic covered stent grafts were deployed,of which 11 patients used two stent grafts(all in dissection cases).The length of the stent was(177.5±24.6)mm.The horizontal diameter of aorta arch at the proximal left subclavian artery ostium was(24.9±2.4)mm,the proximal diameter of the covered stent was(30.5±2.6)mm,and the oversize rate of proximal site was(22.7±4.0)%.The proximal landing zone length was(14.1±5.5)mm.The left subclavian artery ostium was completely covered in 5 patients and partially covered in 32 patients.No blood flow reconstruction was performed.The overall aortic-related mortality was 2.25%(2/89).Among 87 patients,the median follow-up time was 24 months.Postoperative computed tomography angiography scans demonstrated no residual pseudoaneurysm,hematoma or endoleak.One patient complained of mild left upper limb weakness during follow-up due to left subclavian artery occlusion.Neither late death,nor neurological or other complications occurred.Conclusion:Emergency percutaneous endovascular repair is a less invasive and effective approach for the treatment of traumatic blunt aortic injuries.Long-term results remain to be further followed.

Extraperitoneal Rectal Laceration Secondary to Blunt Trauma： Successful Transanal Endoscopic Repair with Hemoclips

Rectal injuries are caused by a variety of causes, such as stab wounds, gunshot injuries, blunt trauma, and foreign bodies. In particular, extraperitoneal rectal injury secondary to blunt trauma is very rare in the civilian setting and usually seen in association with comminuted fractures of the pelvis or sacrum and evidence of intraperitoneal injury.[1] The management of extraperitoneal rectal injury is treated either surgically or conservatively depending on the level and extent of the injury.[2] Currently, management of less severe extraperitoneal rectal injury is not standardized, but primary closure of the wound should be performed whenever possible. Therefore, we present a patient with a laceration of the midrectum secondary to blunt trauma who was successfully treated with endoscopic hemoclipping.