Acute traumatic injuries of the adrenal gland: results of analysis of the Pennsylvania trauma outcomes study registry

Jc, DiGiacomo; Gerber, Noam; Angus, L.D. George; Munnangi, Swapna; Cardozo-Stolberg, Sara

doi:10.1136/tsaco-2020-000487

Cited by 7 publications

(12 citation statements)

References 24 publications

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“…As a result, the right adrenal vein is more susceptible to contusions and oedema, and therefore the right adrenal gland is more likely to undergo acute injury. This appears to be consistent with many reports in the international literature [ 7 ] and is similar in incidence to a large retrospective analysis performed recently by an Australian trauma institute [ 8 ].…”

Section: Discussionsupporting

confidence: 93%

“…Isolated trauma to the adrenal gland is a rare and underreported injury, with an incidence of between 1.5% and 4% of all adrenal trauma cases [1][2][3][4]. Due to its unique anatomy and the mechanism required to result in an isolated injury, adrenal injury is typically unilateral and right-sided [2,[5][6][7][8]. Adrenal gland injury is rare due to its small size, deep retroperitoneal position, and presence of fatty tissue surrounding it; however, the adrenal glands are vulnerable to bleeding due to their extensive network of collateral circulation [9].…”

Section: Introductionmentioning

confidence: 99%

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A Rare Case of an Isolated Left Adrenal Haematoma in Blunt Force Trauma

Izwan¹,

Anderson²

2022

Cureus

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Isolated left adrenal gland injuries following blunt abdominal trauma are extremely rare, accounting for only 1.5-4% of all adrenal trauma cases. Most traumatic injuries are right-sided and associated with other concurrent organ injuries. While acute, unilateral adrenal injuries can be asymptomatic, it is important to recognise the potentially life-threatening complications from haemorrhage and/or adrenal insufficiency. Due to its rarity, there are currently no established guidelines for management, monitoring, or follow-up of adrenal gland trauma. We present a case report of a rare, isolated, post-traumatic left adrenal gland haemorrhage. A 39-year-old man presented with mild abdominal pain following a mountain bike accident. Initial assessment revealed tenderness in the left upper quadrant with normal vital signs and biochemistry, but computer tomography (CT) imaging demonstrated an enlarged left adrenal gland with regional fat stranding and free fluid consistent with an acute adrenal haematoma. He was admitted to the ward for observation and discharged on day three of admission. At a six-week follow-up, he reported a complete resolution in symptoms. Follow-up CT of the adrenals at five months post-injury demonstrated complete resolution of the isolated adrenal haematoma. Post-traumatic isolated left adrenal gland injuries are rare in the reported literature, and this case highlights the lack of current guidelines for management and monitoring in cases of isolated adrenal haemorrhage. The current consensus appears to be appropriate with conservative management and follow-up with serial abdominal CT until the resolution of haemorrhage and/or symptoms.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

A Rare Case of an Isolated Left Adrenal Haematoma in Blunt Force Trauma

Izwan¹,

Anderson²

2022

Cureus

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“…There were few reports comparing the mechanism of injury with and without adrenal injury. The retrospective study by DiGiacomo et al 9 reported that there were no differences. The results of the present study could be explained as the deceleration injury from falls or motorcycle collisions that result in shearing of the juxtamedullary venous sinuses of adrenal glands, rather than direct injury toward the abdomen from wheel injury on motor vehicle crash.…”

Section: Discussionmentioning

confidence: 92%

Blunt adrenal gland injury: The impact of extra-abdominal injury

Tanizaki

Maeda²,

Ishida³

2021

J Trauma Acute Care Surg

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BACKGROUND:Blunt adrenal gland injuries are considered uncommon. Moreover, the factors associated with the mechanisms of the injury following blunt trauma are unclear. In this study, we determined the factors associated with blunt adrenal gland injury (BAGI). MATERIALS AND METHODS: A total of 315 patients with blunt abdominal trauma were admitted to our institution during a 12-year period. After excluding 26 patients who were under 18 years old and 27 patients who were in cardiopulmonary arrest on arrival, 262 eligible patients were retrospectively reviewed. Patient characteristics, mechanism of injury, intervention, and associated organ injuries were compared between those with and without BAGI. RESULTS:Blunt adrenal gland injury was identified in 38 of 262 patients (14.5%). The right side was the predominant site of injury (68%). There were no differences in vital sign, in-hospital mortality, intervention, and concomitant abdominal organ injuries between those with and without adrenal gland injury. Patients with BAGI had a higher frequency of fall and motorcycle collision as mechanisms of injury. In addition, patients with BAGI had a higher injury severity score and a higher frequency of concomitant severe head, chest, and pelvic injuries. CONCLUSION:The results of the present study suggest that the deceleration injury leading to concomitant head, chest, or pelvic injuries with blunt abdominal trauma may be associated with the mechanism of BAGI.

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“…From reports from earlier studies, adrenal trauma is rare. These studies have shown an incidence of up to 2% of adrenal haemorrhage in abdominal traumas 4–6 . Adrenal trauma seems to be associated with more severe injuries and an increased mortality rate 4 .…”

Section: Introductionmentioning

confidence: 99%

“…These studies have shown an incidence of up to 2% of adrenal haemorrhage in abdominal traumas. 4 , 5 , 6 Adrenal trauma seems to be associated with more severe injuries and an increased mortality rate. 4 In postmortem studies, however, the reported incidence of adrenal haemorrhage or injury in trauma patients is higher; 7%–26%.…”

Section: Introductionmentioning

confidence: 99%