The records of 16 patients who suffered blunt thoracic trauma, causing lung lacerations in 13, bronchial disruptions in 2, and lung laceration with bronchial disruption in 1, were reviewed to investigate the correlations between clinical factors and prognosis. The causes of these injuries included 14 traffic accidents and 2 construction-related accidents, and the indications for surgery were massive bleeding in 12 patients, massive air leakage in 2, both in 1, and lung abscess in 1. Of the 16 patients, 11 (68.8%) underwent thoracotomy less than 4 h after admission, 3 (18.8%) underwent thoracotomy 4 to 24 h after admission, and 2 (12.5%) underwent thoracotomy 24 h or later after admission. The operative techniques included 1 pneumonectomy, 5 lobectomies, 2 bronchoplasties, and 8 minor repairs. The mortality rate was 43.7%, which included six early deaths occurring within 72 h of the trauma, and one late death. While major bronchial disruption is usually associated with a good prognosis, univariate and multivariate analyses demonstrated that intrapleural bleeding of 300 ml/h or more from time of trauma to chest tube drainage was significantly correlated with a poor prognosis. Moreover, an injury severity score (ISS) of 36 or more showed a trend toward a correlation with poor prognosis in patients with lung lacerations. Prompt thoracotomy will decrease mortality rate of patients suffering lung lacerations resulting in intrapleural bleeding of more than 300 ml/h.

IntroductionCases of right paraduodenal hernia and superior mesenteric artery syndrome have been reported separately, but their occurrence in combination has not been reported.Case presentationA 46-year-old Japanese man who had never undergone laparotomy was admitted to our hospital due to an acute abdomen. An enhanced multidetector-row computed tomography scan of our patient showed a cluster of small intestines with ischemic change in his right lateral abdominal cavity. Emergency surgery was subsequently performed, and strangulation of the distal jejunum along with incidental right paraduodenal hernia was found. His necrotic ileum was resected, and the jejunum encapsulated by the sac was repaired manually without reduction.Three days after the operation, however, our patient developed vomiting. An upper gastrointestinal series revealed a straight line cut-off sign on the third portion of his duodenum. A second enhanced multidetector-row computed tomography scan showed that he had a lower aortomesenteric angle and a shorter aortomesenteric distance compared to his condition before his right paraduodenal hernia was surgically repaired. We strongly suspected that the right paraduodenal hernia repair may have induced superior mesenteric artery syndrome. On the 21st post-operative day, duodenojejunostomy was performed because conservative management had failed.ConclusionsIn this case, enhanced multidetector-row computed tomography, which permits reconstructed multiplanar imaging, helped us to visually identify these diseases easily. It is important to recognize that surgical repair of a right paraduodenal hernia may cause superior mesenteric artery syndrome.

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