Patient: Female, 86Final Diagnosis: PolytraumaSymptoms: ShockMedication: —Clinical Procedure: Resuscitative endovascular balloon occlusion of the aortaSpecialty: Orthopedics and TraumatologyObjective:Unusual or unexpected effect of treatmentBackground:Non-compressible torso hemorrhage continues to be the leading cause of preventable death in trauma patients. Recent case series report that resuscitative endovascular balloon occlusion of the aorta (REBOA) in the trauma population is a technically feasible method to manage the patients with exsanguinating hemorrhage. On the other hand, it seems that REBOA is being widely promoted prematurely. Complications due to REBOA haven’t been reported much in the literature, and they could have been underestimated.Case Report:An 86-year-old female presented to our emergency department following a pedestrian-vehicle accident. On admission, she was hemodynamically unstable with systolic blood pressure (SBP) of 78 mm Hg. She responded to fluid administration, and computed tomography (CT) scan showed cerebral contusion, subarachnoid hemorrhage, pelvic fracture with contrast extravasation, and thoracic spine fracture. Her condition deteriorated after the CT scan, and she became hemodynamically unstable. REBOA was inserted and inflated. Her blood pressure recovered and even became as high as SBP of 180 mm Hg. Transarterial embolization for pelvic fracture was successfully performed. A subsequent head CT scan showed massive intracranial hemorrhage with penetration to the ventricle, which was fatal. She died on the same day due to cerebral herniation.Conclusions:REBOA is now considered as an alternative to resuscitative thoracotomy or even widely indicated to control hemorrhage. We should be more cautious about using REBOA for polytrauma patients since it could make hemorrhage worse. Further research, assessing its potential complications and safety, will be required to elucidate clear indications for REBOA in trauma populations.

Our data suggest that biloma after NOM of blunt liver injury is common (36 %), but infected biloma is rare. All patients with bilomas were treated using NOM. Most bilomas are self-limited, and NOM is feasible.

Our study suggests that the quality-of-life of Japanese trauma patients generally improved over time, but remained lower than the Japanese national average. Most trauma patients return to home and work within 12 months post-injury.

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