Surgical treatment of mesenteric injuries is necessary to control hemorrhage, manage bowel injuries, and evaluate bowel perfusion. It has recently been suggested that some patients can be managed with transcatheter arterial embolization (TAE) for initial hemostasis. We present a hemodynamically unstable patient who was initially managed by TAE for traumatic mesenteric hemorrhage. A 60-year-old man was injured in a motor vehicle accident and transported to our facility. On arrival, the patient was hemodynamically stable, and had abdominal pain. Physical examination revealed a seatbelt sign on the lower abdomen. A contrast-enhanced computed tomography (CT) scan showed intra-abdominal hemorrhage, mesenteric hematoma, and a giant-pseudoaneurysm, but no intra-abdominal free air or changes in the appearance of the bowel wall. After the CT scan, his vital signs deteriorated and surgical intervention was considered, but TAE was performed to control the hemorrhage. After TAE, the patient was hemodynamically stable and had no abdominal tenderness. A follow-up CT scan was performed 2 days later which showed partial necrosis of the transverse colon and some free air. Resection of the injured transverse colon with primary anastomosis was performed. The patient improved and was discharged 35 days after injury. TAE can be effective as the initial hemostatic procedure in patients with traumatic mesenteric hemorrhage.

A CPR duration < 17 min is independently associated with higher ROSC rates in patients suffering blunt trauma.

In this report, we present the case of a patient with recurrent stomal variceal bleeding treated with partial splenic artery embolization (PSE). The patient, a woman in her 60s, had a history of liver cirrhosis and underwent ileocecal resection for ascending colon carcinoma 6 months earlier. The bleeding did not respond to local treatment. Balloon-occluded retrograde transvenous obliteration (BRTO) was performed via the right superficial epigastric vein. However, gross stomal variceal bleeding recurred 2 months post-BRTO. PSE was therefore performed and satisfactory results were obtained. To the best of our knowledge, this is the first case of recurrent hemorrhage from stomal varices that was successfully treated with PSE in a patient with portal hypertension. We consider PSE to be a minimally invasive and definitive treatment for recurrent stomal variceal bleeding.

A 40-year-old man, with no relevant medical or family history, presented with acute onset left flank pain radiating to his lower back. He was hypertensive (168/75 mmHg); however, his other vital signs were normal. No costovertebral angle knocking pain or abdominal tenderness was elicited. At onset, he complained of left flank pain and subsequently at presentation, he complained of moderate abdominal pain in the lower left quadrant. Laboratory results were normal. Abdominal ultrasound and non-contrast computed tomography (CT) ruled out renal abnormalities, including hydronephrosis or hydroureters (Fig. 1A). However, we undertook contrast-enhanced CT based on a high index of clinical suspicion for vascular lesions because of his persistent abdominal pain. This revealed left-sided noncommunicating isolated renal artery dissection (Fig. 1B,C). Spontaneous renal artery dissection (SRAD) is rare. Ultrasonography and urinalysis are useful in distinguishing between urolithiasis and SRAD. 1 SRAD can cause renal infarction or renovascular hypertension. 2 Treatment options consist of blood pressure control, anticoagulant drugs, endovascular therapy, and open surgery. 3 The absence of urolithiasis and hydronephrosis on noncontrast CT and of hematuria on urinalysis in patients with severe flank pain normally necessitates contrast-enhanced CT to investigate the vascular system for diseases, such as SRAD or acute renal infarction. DISCLOSURE Approval of the research protocol: N/A. Informed consent: Written informed consent was obtained from the patient. Registry and registration no. of the study/trial: N/A.

Background Unnecessary whole-body computed tomography (CT) may lead to excess radiation exposure. Serum D-dimer levels have been reported to correlate with injury severity. We examined the predictive value of serum D-dimer level for identifying patients with isolated injury that can be diagnosed with selected-region CT rather than whole-body CT. Methods This single-center retrospective cohort study included patients with blunt trauma (2014–2017). We included patients whose serum D-dimer levels were measured before they underwent whole-body CT. “Isolated” injury was defined as injury with Abbreviated Injury Scale (AIS) score ≤ 5 to any of five regions of interest or with AIS score ≤ 1 to other regions, as revealed by a CT scan. A receiver operating characteristic curve (ROC) was drawn for D-dimer levels corresponding to isolated injury; the area under the ROC (AUROC) was evaluated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for several candidate cut-off values for serum D-dimer levels. Results Isolated injury was detected in 212 patients. AUROC was 0.861 (95% confidence interval [CI]: 0.815–0.907) for isolated injury prediction. Serum D-dimer level ≤ 2.5 μg/mL was an optimal cutoff value for predicting isolated injury with high specificity (100.0%) and positive predictive value (100.0%). Approximately 30% of patients had serum D-dimer levels below this cutoff value. Conclusion D-dimer level ≤ 2.5 μg/mL had high specificity and high positive predictive value in cases of isolated injury, which could be diagnosed with selected-region CT, reducing exposure to radiation associated with whole-body CT.