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Multiple trauma including pelvic fracture with multiple arterial embolization: an autopsy case report.
Miyake, Takahito; Okada, Hideshi; Kanda, Norihide; Yamaji, Fuminori; Okamoto, Haruka; Ushikoshi, Hiroaki; Noguchi, Kei; Tomita, Hiroyuki; Yoshida, Shozo; Ogura, Shinji.
Afiliação
  • Miyake T; 1Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan.
  • Okada H; 1Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan.
  • Kanda N; 1Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan.
  • Yamaji F; 1Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan.
  • Okamoto H; 1Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan.
  • Ushikoshi H; 1Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan.
  • Noguchi K; 2Department of Tumor Pathology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan.
  • Tomita H; 2Department of Tumor Pathology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan.
  • Yoshida S; 1Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan.
  • Ogura S; 1Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan.
Thromb J ; 18: 3, 2020.
Article em En | MEDLINE | ID: mdl-32140078
ABSTRACT

BACKGROUND:

Pelvic fracture with high energy trauma has a high mortality rate, especially in men. In addition, severe multiple trauma, major hemorrhage, and administration of red blood cells predict mortality in elderly patients with pelvic fracture. We herein report a rare case in which multiple arterial embolization occurred after pelvic fracture. CASE PRESENTATION An 83-year-old male cyclist was transported to our hospital after being struck by a car. On arrival, he was diagnosed with multiple trauma, including rib fractures with hemothorax, lumbar fractures of the transverse process, and injuries in the right acetabulum, left adrenal gland, and liver. He underwent massive transfusion and transcatheter arterial embolization due to extravasation from the right superior gluteal artery and left adrenal gland. On the second day, owing to right lower leg ischemia, serum creatinine kinase and myoglobin levels were markedly elevated from the reference value; hence, a right above-knee amputation was performed 12 h after the accident. However, both protein levels remained high after amputation, resulting in acute renal injury, which was treated via hemodiafiltration on hospital day 3. In addition, sustained low efficiency hemodialysis and plasma exchange were performed on hospital day 4. Despite these treatments, the patient's hemodynamics did not improve, and he died on hospital day 8. The autopsy revealed necropsy of the iliopsoas muscles and the digestive tract.

CONCLUSIONS:

The causes of the patient's death were considered to be persistent rhabdomyolysis and severe hypotension due to iliopsoas necrosis and peritonitis due to digestive tract necrosis. Multiple arterial embolization caused by consumption coagulopathy associated with multiple trauma may account for severe outcomes in this case.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Prognostic_studies Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Prognostic_studies Idioma: En Ano de publicação: 2020 Tipo de documento: Article