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The extracranial internal carotid artery (ICA) refers to the anatomic location that reaches from the common carotid artery proximally to the skull base distally. The extracranial ICA belongs to the C1 segment of the Bouthillier classification and is at considerable risk for injury. Currently, the understanding of endovascular treatment (EVT) for blunt injury of the extracranial ICA is limited, and a comprehensive review is therefore important. In this review, we found that extracranial ICA blunt injury should be identified in patients presenting after blunt trauma, including classical dissection, pseudoaneurysm, and stenosis/occlusion. Computed tomography angiography (CTA) is the first-line method for screening for extracranial ICA blunt injury, although digital subtraction angiography (DSA) remains the “gold standard” in imaging. Antithrombotic treatment is effective for stroke prevention. However, routine EVT in the form of stenting should be reserved for patients with prolonged neurological symptoms from arterial stenosis or considerably enlarged pseudoaneurysm. Endovascular repair is now emerging as a favored therapeutic option given its demonstrated safety and positive clinical and radiographic outcomes.

Background There have been no clinical studies to sufficiently reveal the interaction effect generated by combinations of injury regions of multiple injuries. We hypothesized that certain combinations of trauma regions might lead to increased risk of traumatic death and aimed to verify this hypothesis using a nationwide trauma registry in Japan. Materials and methods This was a retrospective study of trauma patients registered in the Japan Trauma Data Bank between 2004 and 2017. We included patients who suffered blunt trauma with an Injury Severity Score of 16 or more. The trauma was classified into four regions (head, chest, abdomen, and extremities), and a multivariable logistic regression analysis was performed that included interaction terms derived from the combination of two regions as covariates. Results We included 78,280 trauma patients in this study. Among them, 16,100 (20.6%) patients were discharged to death. Multivariable logistic regression showed the odds ratio (OR) of in-hospital death compared with patients without injury of an Abbreviated Injury Scale score of 3 or more in each injured region as follows: head score, 2.31 (95% confidence interval [CI], 2.13-2.51); chest score, 2.28 (95% CI, 2.17-2.39); abdomen score, 1.68 (95% CI, 1.56-1.82); and extremities score, 1.84 (95% CI, 1.76-1.93), respectively. In addition, the ORs of the statistically significant interaction terms were as follows: head-chest 1.29 (95% CI, 1.13-1.48), chest-abdomen 0.77 (95% CI, 0.67-0.88), chest-extremities 1.95 (95% CI, 1.77-2.14), and abdomen-extremities 0.70 (95% CI, 0.62-0.79), respectively. Conclusion In this population, among patients with multiple injuries, a combination of head-chest trauma and chest-extremities trauma was shown to increase the risk of traumatic death. Level of evidence Prognostic, Level III.

Purpose: The blunt abdominal trauma (BAT) is a common emergency and is significantly associated with morbidity and mortality. Our study was conducted to achieve the goal that a new scoring system could be used for the BAT patients. Methods: The statistical population of this study was 1000 patients with BAT referred to emergency department of Imam Hossein Hospital, Tehran, Iran. Sampling was carried out in a convenience non-random manner and continued to reach the required sample size. All the patients with BAT due to road traffic accidents, falls, and other direct blunt traumas such as punctures and kickbacks were included in the study. Exclusion criteria were after 3 months of pregnancy, under the age of 18, warfarin taking, no reliable medical history providing and penetrating trauma. The study questionnaire was based on BAT scoring system. The data were analyzed by SPSS V20 software. The receiver operating characteristic curve was used to analyze the effectiveness of the new scoring system in predicting the BAT patients’ outcome. Results: The mean age of the patients (n = 1000) was (35.79 ± 13.09) years. The mean score of patients was (6.29 ± 5.80). Based on this scoring system, the patients were divided into three categories. The first group was patients at low risk with score of less than 8, the second group was patients at moderate risk with score of 8–12 and the third group was patients at high risk with score of 12–24. The score of 661 (66.1%) patients were low, 109 (10.9%) were moderate and 230 (23%) had a high score. The association between hip fracture and abdominal tenderness with abdominal injury was significant (p

Objective: The aim of this study was to evaluate aortic remodelling and associated complications in patients treated by thoracic endovascular aneurysm repair (TEVAR) for blunt traumatic aortic injuries (BTAI). Methods: This was a retrospective, observational, multicentre study. Remodelling was considered as aortic diameter variations of >2 mm and distal graft and aortic axis angle modification measured by computed tomography angiography (CTA). The predefined levels of measurement were the proximal end of the graft (D1: landing in zone [LZ] 2; D2: LZ 3); distal end (D3); and control measurement (D4) 15 mm beyond D3. Survival, procedure, graft, and/or radiation exposure related complications were registered. CTA was required within three months and at one, six, and 10 years post-operatively. Results: Between 2004 and 2017 52 patients were treated; 47 were included for remodelling analysis (five immediate deaths were excluded); median age was 47 years (range 20–80 years). Mean TEVAR oversizing was 19.6% ± 9.7% (range 5%–35%). Following a median follow up of 67.4 ± 56.1 months (range 14–153 months) survival at one, three, six, and 10 years was 90.4% (standard error [SE] 4.1%), 88.3% (SE 4.5%) 84.8% (SE 5.5%), and 84.8% (SE 5.5%), respectively. There were no procedure/graft related complications except for one late intramural haematoma that required re-intervention. Freedom from aortic remodelling at one, six, and 10 years was 85.1% (SE 5.2%), 30.9% (SE 8.6%), and 24.7% (SE 8.8%), respectively. The increase in D1/D2 and D3 diameters were influenced by time from intervention (both p

Hepatic portal venous gas is defined as tubular areas with decreased enfeeblement around the periphery of the liver. It is a rare finding and associated with various underlying abdominal pathologies, from benign causes to potentially life threatening conditions. Rate of diagnosis of hepatic portal venous gas have been increased due to widespread use of advanced imaging techniques. Existence of gas in the portal veins after blunt abdominal trauma is a temporary incidental finding that could be resolved spontaneously. Here we report an extremely rare condition that describes a child who was suffering from air emboly of the portal veins due to blunt abdominal trauma. The condition was clinically under control and resolved spontaneously.

The aim of the present study is to evaluate the results of traumatic cataract surgery with regard to the type of trauma, mainly in the assessment of visual acuity. Forty-four patients who had been diagnosed with traumatic cataracts were included in this retrospectively designed study. The patients were divided into blunt and penetrating groups according to the type of trauma. Pre- and postoperative ocular findings of the cases were evaluated. Visual acuity, intraocular pressure, intra- and postoperative complications, associated injuries, and surgical approaches were analyzed. Thirty-three of the cases were male (75%) and 11 (25%) were female. There were 23 patients (52.27%) in the blunt group and 21 (47.72%) in the penetrating group. The pre-operative mean vision of the subjects included in the blunt and penetrating groups was 0.82 and 0.96 logMAR, respectively. Ten (22.72%) eyes were hypotonic ( [Med-Science 2019; 8(1.000): 37-41]

Purpose Bulbar injury is the most common type of urethral injury. This study investigated the efficacy and safety of a novel technique, local urethral flushing, in preventing stricture formation after blunt bulbar urethra injuries. Materials and Methods This retrospective study included 205 males diagnosed with straddle injury-induced bulbar urethra injury at the Shanxi Bethune Hospital and First Hospital of Shanxi Medical University between January 2015 and January 2019. Patients were diagnosed by retrograde urethrography and classified as partial or complete urethral rupture according to the urethral integrity after injury. Complete urethral rupture patients received suprapubic cystostomy and received urethroplasty 3 months later. Patients with partial urethral rupture underwent endoscopic urethral realignment by cystoscopic guide-wire guided catheterization. Patients with both injury types were divided into 3 groups. The treatment groups received urethral flushing with 0.05% dexamethasone through a secondary ureteral catheter that locked at the urethral lesion. The blank control groups received normal saline. The negative control groups had only a single ureteral catheter placed. Patients were assessed for pain during catheterization, infection, and stenosis, and followed for at least 2 years. Results Stenosis rates and length were significantly reduced in the normal saline groups, and even further reduced in the dexamethasone groups. The negative control groups had significantly higher infection rates than patients in the dexamethasone or saline groups. Conclusions Local urethral flushing with dexamethasone could significantly decrease urethral stenosis rates and severity without increasing patients’ discomfort or infection risk., Graphical Abstract

Background Endovascular treatment is used for traumatic arterial injuries in the torso. However, the effectiveness of endovascular covered stent‐graft treatment for peripheral artery injury is unclear. We present a case of superficial femoral artery (SFA) injury successfully treated with a covered stent‐graft. Case Report A 68‐year‐old man presented with traumatic lower limb injury and shock. Computed tomography angiography revealed left subtrochanteric fracture and hematoma with extravasation. Digital subtraction angiography revealed extravasation from a left SFA branch, and a pseudoaneurysm at the SFA trunk. We coil embolized the SFA branch, and treated the pseudoaneurysm with a covered stent‐graft. Computed tomography carried out 22 days later showed complete pseudoaneurysm exclusion and sufficient stent patency. Conclusion We successfully used a covered stent‐graft to treat SFA injury due to blunt trauma. A covered stent‐graft could be effective for peripheral artery injury., A 68‐year‐old man presented with lower limb injury and shock after a fall, and digital subtraction angiography revealed extravasation from a proximal branch of the left superficial femoral artery and a pseudoaneurysm at the superficial femoral artery trunk. We used a coil to embolize the superficial femoral arterial branch, and a covered stent graft to treat the pseudoaneurysm. A covered stent graft could be effective for peripheral artery injury; however, the long‐term complications are unclear.

Rationale: Renal vein pseudoaneurysm after blunt trauma is an extremely rare clinical disease. Different interventions, such as conservative, surgical, and endovascular treatments, can be considered. However, previous studies have not described the optimal treatment strategies for this condition. Furthermore, there is a significant lack of prior case reports and of standardized treatment guidelines for trauma-induced renal vein pseudoaneurysm patients who previously maintained antithrombotic agent. Patient concerns: A 23-year-old female patient visited the emergency department after sustaining blunt injury caused by falling. The patient was diagnosed with multiple limb and rib fractures. A right renal vein pseudoaneurysm was found on abdominal computed tomography scan. Initially, there was no other organ damage, and the patient was hemodynamically stable. Thus, nonsurgical, conservative management was considered. However, the patient's hematocrit and hemoglobin levels decreased, and there was no hemodynamic improvement. The patient required lifelong treatment with aspirin because she previously underwent Fontan surgery, and orthopedic surgery for multiple fractures was planned. Thus, considering these factors, the treatment method was changed from conservative management to endovascular stent insertion. Diagnoses: Abdominal computed tomography and renal venography revealed a right renal vein pseudoaneurysm. Interventions: On the basis of the abdominal computed tomography scan and renal venography findings, the endovascular stent graft was inserted across the pseudoaneurysm area. Outcomes: Upon placement of the endovascular stent, hemoglobin and hematocrit levels gradually returned to normal. The patient's vital signs and general condition had improved. The patient recovered without any complications and was discharged 29 days after hospitalization. Lessons: Some patients with traumatic renal vein pseudoaneurysm do not experience hemodynamic improvement despite conservative treatment. Hence, endovascular procedure may be considered for these patients, particularly those who require antithrombotic treatment for a previous disease.

Purpose Proper use of antibiotics during emergency abdominal surgery is essential in reducing the incidence of surgical site infection. However, no studies have investigated the type of antibiotics and duration of therapy in individuals with abdominal trauma in Korea. We aimed to investigate the status of initial antibiotic therapy in patients with solitary abdominal trauma. Methods From January 2015 to December 2015, we retrospectively analyzed the medical records of patients with solitary abdominal trauma from 17 institutions including regional trauma centers in South Korea. Both blunt and penetrating abdominal injuries were included. Time from arrival to initial antibiotic therapy, rate of antibiotic use upon injury mechanism, injured organ, type, and duration of antibiotic use, and postoperative infection were investigated. Results Data of the 311 patients were collected. The use of antibiotic was initiated in 96.4% of patients with penetrating injury and 79.7% with blunt injury. Initial antibiotics therapy was provided to 78.2% of patients with solid organ injury and 97.5% with hollow viscus injury. The mean day of using antibiotics was 6 days in solid organ injuries, 6.2 days in hollow viscus. Infection within 2 weeks of admission occurred in 36 cases. Infection was related to injury severity (Abbreviated Injury Scale of >3), hollow viscus injury, operation, open abdomen, colon perforation, and RBC transfusion. There was no infection in cases with laparoscopic operation. Duration of antibiotics did not affect the infection rate. Conclusion Antibiotics are used extensively (84.2%) and for long duration (6.2 days) in patients with abdominal injury in Korea.

BACKGROUND Traumatic cataract is common presentation of penetrating and blunt ocular trauma in children. Ocular trauma is the leading cause of unilateral blindness all over the world. The incidence of ocular trauma varies in different parts of the world. From India, the reported incidence is 20.53%. Traumatic cataract causes significant blindness in paediatric populations particularly in developing countries. The aim of the study is to evaluate the final visual outcome of the patients with traumatic cataract. MATERIALS AND METHODS We conducted a prospective study of 100 children from 4 to 16 years of age presenting in Outpatient Department of Regional Institute of Ophthalmology, Kolkata, with traumatic cataract between April 2015 to March 2017. Detailed history, systemic and local examinations and relevant investigations done followed by medical and surgical intervention and patients were followed up till six months and final visual acuity recorded. RESULTS There was a male predilection with a male-to-female ratio 2.85:1.56 (56%) patients sustained penetrating trauma, while 44 (44%) were inflicted with blunt injury. Commonest causative agent was trauma with organic foreign bodies in 20 eyes (20%) followed by stones in 14 eyes (14%). Anterior segment was more involved than posterior segment. Final best corrected visual acuity after six months was better than or equal to 6/18 in 64 eyes (64%). The major early postoperative complications include anterior uveitis in 26 (26%) and corneal oedema in 8 (8%) patients, while late postoperative complication was posterior capsular uveitis in 36% patients. CONCLUSION Paediatric traumatic cataract can cause ocular morbidity. Timely and proper medical and surgical intervention can result in good visual outcome. The parents, caretakers and teachers have an important role to play in prevention by recognising hazardous situation and taking preventing measures.

Blunt renal artery injury (BRAI) is a rare finding with incidence ranging from 0.05% to 0.08% among blunt abdominal trauma patients. BRAI occurs in 1% to 4% of patients with renal injury, and the most common cause is motor vehicle accidents. An unusual case of BRAI in a 47-year-old man at work is reported. The victim accidentally fell from a scaffold (approximately 3 m in height). He was transported to the hospital where he was intubated, but he died after 30 min despite the cardio-pulmonary resuscitation. Surveillance cameras showed the man falling from the scaffold, but his impact with the ground was not captured. At autopsy, except for an oval bruise on the left hypochondrium, no external injury was found. The same mark was noticed on the shirt worn by the victim. Bilateral ribs fractures were found. The abdominal cavity was filled with 2 l of fresh blood and clots as a consequence of a complete transection of the left renal artery. Investigation of the workplace revealed a partial footprint on the external side of the scaffold, matching shoes worn by the victim. On the ground, a metallic pedestrian gate with a 1 m high post was found placed just below the scaffold. It was concluded that the man hit the gate’s post as intermediate impact after the fall, which caused the oval bruise, ribs fractures, and the rupture of the left renal artery without injury of the internal organs.

Objective: We aimed to evaluate the etiology, traumatic pathology and treatment of tho-racic trauma patients who were treated in thoracic surgery clinic.Methods: Patients with thoracic trauma admitted to the thoracic surgery clinic between September 2017 and September 2019 were evaluated retrospectively in terms of age, gen-der, types of trauma, thoracic and extrathoracic injuries, treatments and hospitalization time.Results: The mean age of 119 patients (92 males and 27 females) was 43.65 years. Eighteen (15.1%) patients were presented with penetrating trauma and 101 (84.9%) patients with blunt thoracic trauma. The most common pathologies in blunt traumas were rib fracture and contusion and in penetrating traumas were pneumothorax and hemothorax. Medical treatment was usually sufficient for patients with blunt thoracic trauma. The most common surgical method in penetrating injuries were tube thoracostomy.Conclusion: Thoracic traumas must be treated quickly and effectively due to their high mortality rates., Göğüs cerrahisi kliniğinde yatırılarak tedavi edilen toraks travma hastalarının etyoloji, travmatik patoloji ve tedavi açısından değer-lendirmeyi amaçladık.Gereç ve Yöntem: Eylül 2017-Eylül 2019 tarihleri arasında travma nedeniyle başvuran ve göğüs cerrahisi kliniğine yatırılarak tedavi edilen toraks travmalı hastalar yaş, cinsiyet, travma şekli, torasik ve ekstratorasik yaralanmaları, uygulanan tedaviler, hastanede yatış süreleri açısın-dan retrospektif olarak incelendi. Elde edilen verilerek istatistiksel olarak değerlendirildi.Bulgular: Çalışmamıza dahil olan 92’si erkek, 27’si kadın 119 hastanın ortalama yaşları 43.65±1.71 idi. Hastaların 18'i (%15.1) penetran, 101'i (%84.9) ise künt toraks travması nedeniyle başvurmuştu. Künt travmalarda en sık rastalanan patolojiler kot fraktürü ve kontüzyonken, penetran travmalarda en sık rastlanan patolojiler pnömotoraks ve hemotorakstı. Künt toraks travmalı hastalara medikal tedavi çoğunlukla yeterli olurken, penetran yaralanmalarda en sık kullanılan cerrahi yöntem tüp torakostomiydi.Sonuç: Toraks travmaları yüksek mortalite oranları nedeniyle hızlı ve etkin tedavi edilmesi gereken patolojilerdir.

Pericardio-diaphragmatic hernias (PDHs) are exceedingly rare. When found in adults, they are most commonly caused by blunt trauma and require immediate repair. We report a case of a 61-year-old female who presented with shortness of breath, chest pain and fatigue one month after a motor vehicle collision. Imaging revealed an anterior diaphragmatic rupture with herniation of transverse colon and omentum into the left hemithorax with mass effect on the anterior heart. She underwent exploratory laparotomy revealing a pericardio-diaphragmatic hernia with contents further herniating through a lateral pericardial defect into the left chest. The pericardio-diaphragmatic defect was repaired primarily with non-absorbable sutures. There is an average of only one case report of PDH annually and to our knowledge, this is the first report of pericardio-diaphragmatic hernia with concomitant lateral pericardial defect with herniation of contents into the chest. Keywords: Blunt injury, Diaphragmatic hernia, Pericardio-diaphragmatic hernia, Diaphragmatic rupture

Highlights • Inferior vena cava injury is a rare injury with high rate mortality. • Few clinical cases have described the clinical findings and radiologic appearance of this kind of injury. • We describe a rare clinical case of inferior vena cava hematoma. • The management depends on the hemodynamic stability of the patient and the level of injury, it might be surgical, endoscopic., Introduction inferior vena cava IVC injury is rare with lethal outcomes, the clinical signs depends on the location and associated injuries, andt he treatment might be endovascular, surgical. Clinical case A 25 years with no medical history was admitted to the emergency department after a car accident. After intubation and hemodynamic stabilization, the computerized tomography CT scan showed hepatic laceration with a rupture of the IVC in the retro-hepatic portion, he was admitted to the operation room for damage control laparotomy; the patient died 12 h after the operation despite appropriate management. Conclusion IVC are rare and lethal, the CT scan remains the gold standard and the evolution of endovascular techniques decreased the mortality rate.

Extracorporeal membrane oxygenation (ECMO) has been used successfully in critically ill patients with traumatic lung injury and offers an additional treatment modality. ECMO is mainly used as a bridge treatment to delayed surgical management; however, only a few case reports have presented the successful application of ECMO as intraoperative support during the surgical repair of traumatic bronchial injury. A 38-year-old man visited our hospital after a blunt chest trauma. His chest imaging showed hemopneumothorax in the left hemithorax and a finding suspicious for left main bronchus rupture. Bronchoscopy was performed and confirmed a tear in the left main bronchus and a congenital tracheal bronchus. We decided to provide venovenous ECMO support during surgery for bronchial repair. We successfully performed main bronchial repair in this traumatic patient with a congenital tracheal bronchus. We suggest that venovenous ECMO offers a good option for the treatment of bronchial rupture when adequate ventilation is not possible.

Nakao, S., Katayama, Y., Hirayama, A. et al. Trends and outcomes of blunt renal trauma management: a nationwide cohort study in Japan. World J Emerg Surg 15, 50 (2020). https://doi.org/10.1186/s13017-020-00329-w, Background: There is a paucity of information for predicting patient outcomes other than the American Association for the Surgery of Trauma (AAST) renal injury scale. The aim of this study was to evaluate the association between the patient characteristics and outcomes of patients with blunt renal trauma using a nationwide database in Japan. Methods: We performed a retrospective analysis of the Japan Trauma Data Bank (JTDB) from 2004 to 2018. We identified patients with blunt renal trauma by AIS codes converted to AAST grades. We evaluated trends in patient characteristics and management and assessed factors associated with mortality and nephrectomy using a multivariable logistic regression analysis. Results: We identified 3550 patients with blunt renal trauma. Their median age was 43 years and 74.2% were male. Nephrectomy was performed in 3.8%, and the overall mortality rate was 9.5%. We found increasing trends in age and emergency abdominal angiography and decreasing trends in nephrectomy and mortality over the 15-year period. The following factors were associated with mortality: Age ≥ 65 years (adjusted OR 3.36); pedestrian accident (adjusted OR 1.94); fall from height (adjusted OR 1.91); shock on arrival (adjusted OR 4.02); concomitant injuries to the head/neck (adjusted OR 3.14), pelvis/lower-extremity (adjusted OR 1.59), liver (adjusted OR 1.68), spleen (adjusted OR 1.45), and gastrointestinal tract (adjusted OR 1.90); AAST grades III-V (adjusted ORs 1.42, 2.16, and 5.55); and emergency abdominal angiography (adjusted OR 0.70). The following factors were associated with nephrectomy: Shock on arrival (adjusted OR 1.98), concomitant injuries to the thorax (adjusted OR 0.46) and spleen (adjusted OR 2.07), AAST grades III, IV, and V (adjusted ORs 18.40, 113.89, and 468.17), and emergency abdominal angiography (adjusted OR 0.28). Conclusions: We demonstrated that the AAST grade and emergency angiography were associated with mortality and nephrectomy in blunt renal trauma in the Japanese population.

Traumatic abdominal wall hernia with evisceration is an uncommon injury secondary to blunt abdominal trauma in all age groups. Bicycle handlebar injuries among children are significant causes of blunt abdominal trauma such as penetrating trauma. We present a case of evisceration in a 14-year-old child after blunt injury with handle bar. We assume that early management and prompt abdominal exploration and surgical repair provide good clinical outcome without complication.

Purpose Postoperative pancreatic fistula is a serious and fatal complication of gastrectomy for gastric cancer. Blunt trauma to the parenchyma of the pancreas can result from an assistant's forceps compressing and retracting the pancreas, which in turn may result in pancreatic juice leakage. However, no published studies have focused on blunt trauma to the pancreas during laparoscopic surgery. Our aim was to investigate the relationship between compression of the pancreas and pancreatic juice leakage in a swine model. Materials and Methods Three female pigs were used in this study. The pancreas was gently compressed dorsally for 15 minutes laparoscopically with gauze grasped with forceps. Pancreatic juice leakage was visualized by fluorescence imaging after topical administration of chymotrypsin-activatable fluorophore in real time. Amylase concentrations in ascites collected at specified times was measured. In addition, pancreatic tissue was fixed with formalin, and the histology of the compressed sites was evaluated. Results Fluorescence imaging enabled visualization of pancreatic juice leaking into ascites around the pancreas. Median concentrations of pancreatic amylase in ascites increased from 46 U/L preoperatively to 12,509 U/L 4 hours after compression. Histological examination of tissues obtained 4 hours after compression revealed necrotic pancreatic acinar cells extending from the surface to deep within the pancreas and infiltration of inflammatory cells. Conclusions Pancreatic compression by the assistant's forceps can contribute to pancreatic juice leakage. These findings will help to improve the procedure for lymph node dissection around the pancreas during laparoscopic gastrectomy.

Blunt traumatic aortic injury is the second leading cause of death after motor vehicle accidents. The most frequent localisation of aortic lesion is the isthmus, especially in those who survived the accident. Here we report a case of blunt traumatic aortic injury with unusual localisation and modality. A 31 years old man sustained a motorcycle accident, being run over by a car. Computed tomography scan showed an atypical ascending aorta lesion, confirmed by intraoperative finding. The patient underwent emergency ascending aorta replacement with Dacron tubular graft. The patient was discharged uneventfully on 35th postoperative day, after multiple maxillofacial surgeries for concomitant injuries. Keywords: Ascending aorta, Blunt injury, Aortic dissection

Objectives To analyze the early and long-term survival and re-intervention rate in patients undergoing TEVAR for blunt traumatic thoracic aortic injury. Methods This was a consecutive case series. Between the years 2001 and 2010, a total of 74 patients underwent TEVAR for blunt traumatic thoracic aortic injury at four tertiary referral centers, three in Sweden and one in Switzerland. The median age of the patients was 41 years, and 16% were women. Demographic, procedural, and outcome data were collected and reviewed retrospectively. The patients were followed up during 2013–2014. Results Early (30 day) mortality was 9% (7 patients), with only two cases directly related to the aortic injury; in hospital mortality was 14% as three patients died during the primary hospital admission within the first 6 months. Most patients had sustained severe injuries to other organ systems, and among all in hospital deaths brain injury was the predominant cause. Five year survival in the whole group was 81%. Re-intervention was needed in 16% (12 patients) during the first year, half of them within the first month. Only one patient underwent re-intervention more than 1 year after the initial procedure. Infolding and partial stentgraft collapse was the reason for the secondary procedure in five of the 13 patients; in three it occurred within 3 weeks of the acute TEVAR. Conclusion TEVAR allows rapid and effective therapy in trauma patients with blunt aortic injury. The outcome is dependent on the severity of the concomitant injuries. The treatment is durable during the first decade after the procedure, but even longer follow up is needed to determine the impact of TEVAR in young patients on the degenerative changes that take place in the aging aorta.

BACKGROUND & OBJECTIVES Ileal perforation is one of the commonest occurrence in our hospital setup, with the majority of cases having an aetiology of trauma. The aim is to study the various causes of ileal perforation and its presentation and various surgical procedure and its complications and factors affecting the outcome. METHODS Seventy cases of ileal perforation were included in this study. Factors were tabulated and statistically analysed to study their contribution. RESULTS Trauma was the most common cause of ileal perforation in this study followed by nonspecific perforations. Patients presented primarily in the third and fourth decades of life with a male preponderance. Many patients had air under diaphragm in x-rays and underwent surgery within 24 hrs. of onset. 70% of patients underwent 2-layer closure with complication rate of 67% and mortality rate of 5.7%. CONCLUSION We found trauma as the most common aetiology for ileal perforation. Incidence of typhoid induced perforations seems to have significantly reduced. Faecal peritonitis, age, shock, lag period were found to be significant in contributing to mortality and morbidity.

Objective: To determine the predictive value of repeated abdominal ultrasonography in patients with multiple trauma and decreased level of consciousness (LOC). Methods: This prospective cross-sectional study was conducted over a six-month period at Shahid Rajaee Trauma Hospital, Shiraz, Iran. We included hemodynamically stable blunt abdominal trauma patients with a decreased LOC (Glasgow Coma Scale ≤ 13) who were referred to the neurosurgery ICU ward. Included cases underwent 1 contrast-enhanced CT scan and two-time ultrasonographic study of the abdomen with an interval of 48 hours. The diagnostic accuracy of the ultrasonography was determined according to the CT-scan results. Results: Overall 80 patients with mean age of 37.75 ± 18.67 years were included. There were 17 (21.3%) women and 63 (78.8%) men among the patients. Compared with the CT-Scan, the first ultrasonography showed a sensitivity of 60%, specificity of 80%, PPV of 16.60%, NPV of 96.80%, and a diagnostic accuracy of 70%. The same values for the second ultrasonographic study were 80%, 79%, 20%, 98%, and 79%, respectively. In 4 (5%) patients whose first ultrasonography and CT scan results were negative, the second ultrasonography was positive for injury. Conclusion: In patients with blunt trauma to the abdomen, when the only indication of abdominal CT scan is a decreased LOC, two ultrasonographic studies can replace a CT imaging.

A case series of abdominal wall hernia following blunt injury is essential for the understanding of its varied clinical presentation. The purpose of this paper is to emphasise on the fact that abdominal wall hernia is seemingly benign yet completely treatable condition and can be easily missed without proper clinical examination. A timely intervention with proper intraoperative assessment and decision making is needed. Immediate primary tissue repair is the preferred mode of management. Laparoscopic intervention in these scenarios is possible with better knowledge of the mechanism of injury and probable outcomes.

Nonoperative management of both blunt and penetrating injuries can be challenging. During the past three decades, there has been a major shift from operative to increasingly nonoperative management of traumatic injuries. Greater reliance on nonoperative, or “conservative” management of abdominal solid organ injuries is facilitated by the various sophisticated and highly accurate noninvasive imaging modalities at the trauma surgeon's disposal. This review discusses selected topics in nonoperative management of both blunt and penetrating trauma. Potential complications and pitfalls of nonoperative management are discussed. Adjunctive interventional therapies used in treatment of nonoperative management-related complications are also discussed. Republished with permission from: Stawicki SPA. Trends in nonoperative management of traumatic injuries – A synopsis. OPUS 12 Scientist 2007;1(1):19-35.

Cyclodialysis clefts are rare. The most common reason for presentation is blunt ocular trauma followed by various iatrogenic interventions. Although gonioscopy is the gold standard technique, diagnosis is particularly challenging, and various noninvasive techniques such as ultrasound biomicroscopy and the newer anterior segment swept-source optical coherence tomography have been found effective. The management of cyclodialysis clefts should be conservative initially followed by a variety of nonsurgical and surgical modalities to achieve closure. In this article, we report the most recent developments in the diagnosis and surgical and nonsurgical treatment strategies of cyclodialysis cleft. An extensive literature search was done using PubMed and Google Scholar with the search terms such as cyclodialysis cleft, ocular hypotony, hypotony maculopathy, cyclopexy, and cyclotamponade.

Blunt popliteal vascular injury in the paediatric population is exceedingly rare and in advanced trauma centres the management can be challenging. A case of blunt popliteal artery trauma in a 5 years old requiring distal bypass using reversed saphenous vein is herein described. It is noteworthy to mention the difficulties experienced in a limited resource setting, including limitations in small rural hospitals, inefficient timely transfer to specialised centres, inadequate numbers of highly trained surgeons in subspecialities such as microvascular surgery and finally ineffective support and rehabilitative services.

Background Blunt chest injury is not uncommon in trauma patients. Haemothorax and pneumothorax may occur in these patients, and some of them will develop retained pleural collections. Video-assisted thoracoscopic surgery (VATS) has become an appropriate method for treating these complications, but the optimal timing for performing the surgery and its effects on outcome are not clearly understood. Materials and methods In this study, a total of 136 patients who received VATS for the management of retained haemothorax from January 2003 to December 2011 were retrospectively enrolled. All patients had blunt chest injuries and 90% had associated injuries in more than two sites. The time from trauma to operation was recorded and the patients were divided into three groups: 2–3 days (Group 1), 4–6 days (Group 2), and 7 or more days (Group 3). Clinical outcomes such as the length of stay (LOS) at the hospital and intensive care unit (ICU), and duration of ventilator and chest tube use were all recorded and compared between groups. Results The mean duration from trauma to operation was 5.9 days. All demographic characteristics showed no statistical differences between groups. Compared with other groups, Group 3 had higher rates of positive microbial cultures in pleural collections and sputum, longer duration of chest tube insertion and ventilator use. Lengths of hospital and ICU stay in Groups 1 and 2 showed no statistical difference, but were longer in Group 3. The frequency of repeated VATS was lower in Group 1 but without statistically significant difference. Discussion This study indicated that an early VATS intervention would decrease chest infection. It also reduced the duration of ventilator dependency. The clinical outcomes were significantly better for patients receiving VATS within 3 days under intensive care. In this study, we suggested that VATS might be delayed by associated injuries, but should not exceed 6 days after trauma.

Introduction: This is very rare case report regarding late ventricular septal defect (VSD) following blunt trauma. Case Report: A 23-year-old motorcycle rider lost control and crashed to another motorcycle. He was transferred to emergency department by emergency medical services. Initial evaluation revealed some minor trauma which was managed, and he was discharged. There was a lately developed large apical VSD with delayed cardiopulmonary deterioration. The defect was recognized more than 10 days after accident, and repaired the day after. Discussion: Most VSD patients with blunt trauma remain asymptomatic following trauma while those with no primary findings experience gradual decompensation.

The aim of the present study was to evaluate acute blunt pancreatic injury using contrast-enhanced ultrasonography (CEUS) in comparison with contrast-enhanced computed tomography (CECT). Superficial and deep lesions were established by blunt pancreatic injury in 40 Chinese Guangxi Bama miniature pigs. Conventional ultrasound (US), CEUS and CECT were performed to detect traumatic lesions in the pancreas. A total of 40 lesions were established, including 20 deep lesions and 20 superficial lesions. US identified 21 of the 40 lesions, including 7 of the 20 superficial and 14 of the 20 deep lesions. CEUS identified 34 of the 40 lesions, including 14 of the 20 superficial and 20 of the 20 deep lesions. CECT identified 33 of the 40 lesions, including 13 of the 20 superficial and 20 of the 20 deep lesions. The detection rate of acute blunt pancreatic injury using CEUS was significantly higher compared with that using US (85 vs. 52.5%, P0.05). CEUS improves the diagnostic levels of conventional US and is comparable with CECT scans in the diagnosis of blunt pancreatic injury.

Management of isolated traumatic pancreatic duct disruption remains challenging due to associated morbidity and mortality. Two children with isolated pancreatic ductal disruption were treated conservatively. Both developed a pseudocyst which resolved spontaneously due to the atrophy of the distal pancreas in a five-year-old girl while remained persistent and was treated by endoscopic cystogastrostomy in an eight-year-old boy. Non-operative management may be pursued in patients with pancreatic ductal injury in the hope of a pseudocyst formation which may spontaneously resolve or may be treated later with a minimally invasive procedure. However, the literature review precludes its practice as a standard due to high incidence of associated complications of non-operative management.

Traumatic ventricular septal defect (VSD) resulting from blunt chest injury is a very rare event. The mechanisms of traumatic VSD have been of little concern to dateuntil now, but two dominant theories have been described. In one, the rupture occurs due to acute compression of the heart; in the other, it is due to myocardial infarction of the septum. The clinical symptoms and timing of presentation are variable, so appropriate diagnosis can be difficult or delayed. Closure of traumatic VSD has been based on a combination of heart failure symptoms, hemodynamics, and defect size. Here, we present a case of a 4-year-old boy who presented with a traumatic VSD following a car accident. He showed normal cardiac structure at the time of injury, but after 8 days, his repeated echocardiography revealed a VSD. He was successfully treated by surgical closure of the VSD, and has been doing well up to the present. This report suggests that the clinician should pay great close attention to the patients injured by blunt chest trauma, keeping in mind the possibility of cardiac injury.

Introduction: One of the most common presentations of blunt and penetrating ocular trauma is traumatic cataract. It remains a significant cause of visual impairment and physical disability among adults and children. It is associated with various ocular injuries. Aim: To evaluate the associated ocular injuries and final outcome of patients with traumatic cataract along with their demographic features and modes of trauma. Materials and Methods: A prospective study done in Department of Ophthalmology in M.L.B. Medical college, Jhansi from February 2010 to July 2011. A total of 48 patients diagnosed as a case of traumatic cataract were subjected to a detailed history, systemic and local examination with relevant investigations. Medical or surgical managements were done accordingly. Patients were subsequently followed-up and visual acuity was recorded. Appropriate statistical tests were applied. Results: A 54.2% patients sustained penetrating trauma while 45.8% got blunt injury. Out of total, 79% patients were males while 50% were less than 15 years of age. Causative agents were stone, wood items, stick, metal objects etc. Among blunt trauma cases, 64% of the patients had visual acuity 6/18. Anterior segment was more involved as compared to posterior segment. A 38.5% patients had corneal opacity among penetrating injury patients. The interval between trauma and surgery was less than one month among 75% of patients. After three months of surgery, 43.7% patients had visual acuity of >6/18. Conclusion: This study provides recent data of patients hospitalized after ocular trauma and diagnosed as a case of traumatic cataract. Traumatic cataract occurs mostly in younger males. Surgical intervention is necessary to improve visual outcome. Good visual outcome was obtained in nearly half of the patients. Traumatic cataract patients can have good visual outcome depending upon proper management.

An interesting case of homicide involving the use of a heavy glass ashtray is described. The victim, a 81-years-old woman, has survived for few days and died in hospital. The external examination of the victim showed extensive blunt and sharp facial injuries and defense injuries on both the hands. The autopsy examination showed numerous tears on the face, as well as multiple fractures of the facial bones. Computer tomography scan, with 3D reconstruction, performed in hospital before death, was used to identify the weapon used for the crime. In recent years new diagnostics tools such as computer tomography has been widely used, especially in cases involving sharp and blunt forces. Computer tomography has proven to be very valuable in analyzing fractures of the cranial teca for forensic purpose, in particular antemortem computer tomography with 3D reconstruction is becoming an important tool in the process of weapon identification, thanks to the possibility to identify and make comparison between the shape of the object used to commit the crime, the injury and the objects found during the investigations. No previous reports on the use of this technique, for the weapon identification process, in cases of isolated facial fractures were described. We report a case in which, despite the correct use of this technique, it was not possible for the forensic pathologist to identify the weapon used to commit the crime. Authors wants to highlight the limits encountered in the use of computer tomography with 3D reconstruction as a tool for weapon identification when facial fractures occurred.

There is a consensus that blunt traumatic intraperitoneal bladder rupture should undergo water-tight suturing and be decompressed by a transurethral catheter. This is the first report of the non-operative management of blunt traumatic intraperitoneal bladder rupture with a severe pelvic fracture. A 32-year-old male was run over by a power shovel, and brought to our emergency department. Upon arrival, he was in severe shock because of massive bleeding from a severe pelvic fracture. Transcatheter arterial embolization and an external fixation for the pelvic fracture was performed. Retrograde cystography showed an intraperitoneal bladder rupture. On the day of admission, the non-operative management of the intraperitoneal bladder rupture was performed to prevent additional bleeding. We could continue the conservative management on the day after admission because urine could be constantly drained. At one week after admission, the bladder rupture healed. The non-operative management for an intraperitoneal bladder rupture with a severe pelvic fracture is an important treatment modality in order to carry out damage control after a severe pelvic fracture. Such non-operative management can be continued when a celiotomy is not needed for other abdominal organ injuries, no intravesical bone spicule is detected, and urine can be constantly drained.

Objectives To show the wide spectrum of computed tomography (CT) findings in blunt renal trauma and to correlate them with consequent therapeutic implications. Methods This article is the result of a literature review and our personal experience in a level II trauma centre. Here we describe, discuss and illustrate the possible CT findings in blunt renal trauma, and we correlate them with the American Association for the Surgery of Trauma (AAST) classification and their therapeutic implications. Results CT findings following blunt renal trauma can be grouped into 15 main categories, 12 of them directly correlated with the AAST classification and 3 of them not mentioned in it. Non-operative management, which includes the “watchful waiting” approach, endourological treatments and endovascular treatments, is nowadays widely adopted in blunt renal trauma, and surgery is limited to haemodynamically unstable patients and a minority of haemodynamically stable patients. Conclusions The interpretation of CT findings in blunt renal trauma may be improved and made faster by the knowledge of their therapeutic consequences. Teaching Points • The majority of blunt renal injuries do not require surgical treatment. • CT findings in blunt renal injury must be evaluated considering their therapeutic consequences. • Some CT findings in blunt renal trauma are not included in the AAST classification.

Cardiac injuries rarely occur during blunt chest traumas which frequently develop as a result of motor vehicle accidents. Cardiac injuries can be often overlooked in cases of cardiac injuries following blunt chest trauma due to the frequent co-existence of other organ injuries. The mortality rate is increases unless such injuries are recognized on time and treated urgently. In this article, we report a successful treatment with right thoracotomy of a 48-year-old female case who developed massive hemothorax due to an isolated right atrial rupture which was associated with blunt chest trauma and multiple organ injury following a traffic accident.

Blunt carotid injuries may causenot only spasm, intimal rupture or mural contusion,but they can also lead to more serious lesions suchas dissection resulting in a pseudoaneurysm, orocclusion of the involved carotid artery. The mostcommonly affected site is the internal carotid artery(ICA) directly distal to the bifurcation, whereas thedistal portion of the ICA is less commonly injured.

Forensic expertise has not specified with certainty any specific injury among fatally injured frontal car-occupants in frontal car collisions.To establish if blunt injuries of thoracic aorta, heart, and pericardium could be used as predictors where the fatally injured car-occupant was at the moment of car-collision.A retrospective autopsy study was performed. The subjects were fatally injured car-drivers, front-seat and rear-seat passengers in head-on car collisions. In each of them we analyzed the injuries of thoracic aorta, heart and pericardium.492 subjects were analysed (378 male and 104 female): 239 car-drivers, 194 front-seat and 49 rear-seat passengers. The isthmus of aorta was the commonest site of simple blunt rupture among car-drivers and front-seat passengers. Among more than half of the observed subject, there was aortic blunt rupture as concomitant injury with heart and pericardium injuries. Heart and pericardium ruptures were most common among fatally injured car-drivers. Most frequently injured part of the heart was the right atrium. Injuries of thoracic aorta, heart and pericardium indicated a higher probability that the fatally injured would be the car-driver (lambda = 0.818; df = 2; p = 0.011, lambda = 0.906; df = 2; p = 0.000, and lambda = 0.951; df = 2; p =0.000); this was also pointed out by the rupture of the right atrium and multiple ruptures of the thoracic aorta (lambda = 0.966; df = 2; p = 0.000 and lambda = 0.918; df = 2; p = 0.009). The concomitant injuries of the thoracic aorta with thoracic spine, sternum and heart pointed out that the injured person was the car-driver (lambda = 0.971; df = 4; p = 0.007, lambda = 0.974; df = 4; p = 0.013 and lambda = 0.958; df = 4; p = 0.000), as well as the concomitant injuries of heart and sternal fracture (lambda = 0.960; df = 4; p = 0.001). The probability of about 80% that the fatally injured person in head-on collisions was a car-driver was pointed out by concomitant blunt thoracic aorta rupture with fractured sternum and ribs (Wald. coeff. = 8.611; df = 1; p = 0.003, and Wald. coeff. = 3.875; df = 1; p = 0.049).The basic mechanism of the injury of thoracic organs is deceleration, as well as anteroposterior compression with caudorostral hyperextension. That is why thoracic organ injuries are mostly concomitant. Fatally injured car-drivers suffered more often of these injuries than other car-occupants. The probability that the fatally injured was the car-driver rises with the number of concomitant injuries of thoracic aorta, heart and pericardium, as well as with the fractured thoracic-cage bones.

Blunt diaphragmatic lesions (BDL) are uncommon in trauma patients, but they should be promptly recognized as a delayed diagnosis increases morbidity and mortality. It is well known that BDL are often overlooked at initial imaging, mainly because of distracting injuries to other organs. Sonography may directly depict BDL only in a minor number of cases. Chest X-ray has low sensitivity in detecting BDL and lesions can be reliably suspected only in case of intra-thoracic herniation of abdominal viscera. Thanks to its wide availability, time-effectiveness and spatial resolution, multi-detector computed tomography (CT) is the imaging modality of choice for diagnosing BDL; several direct and indirect CT signs are associated with BDL. Given its high tissue contrast resolution, magnetic resonance imaging can accurately depict BDL, but its use in an emergency setting is limited because of longer acquisition times and need for patient’s collaboration.

To describe the epidemiologic features of work-related eye injuries in Kaohsiung, a hospital-based study was performed. Four hundred and eighty-six patients who were treated at emergency service or were admitted to the ophthalmology ward over a 4-year period were reviewed. Among these, 38.9% of eye injuries in the study were work-related. Male workers had a 3.99 higher odds ratio (OR) than females to suffer from eye injuries (95% confidence interval [CI], 1.99-8.04). Most of the work-related eye injuries occurred in subjects who were 30-49 years old (OR, 3.02, and 95% CI, 1.56-5.82, when compared with those aged < or = 29 years). The most common type of eye injury in the occupational exposure group was foreign body injury (31.2%), followed by blunt injuries (20.6%), chemical burn (19.6%), UV light radiation (12.7%), and corneal abrasions (11.6%). On the other hand, in the non-occupational exposure group, the most common types of eye injury were blunt injuries (43.4%), corneal abrasions (28.3%), and foreign body injury (20.2%). Our study found that foreign body injury and blunt injuries were the two highest priority injuries for which prevention strategies should be developed in Kaohsiung city. Furthermore, after advanced examination of types of media that caused eye injuries, we found that being hit by wooden objects around the eye, by flying objects in the eye, and by welding flashes are important risk factors for workers to avoid. In conclusion, most of the occupational eye injuries occurred among male workers aged 30-49 years. Due to the lack of an occupational eye injury surveillance system to monitor the incidence of eye injuries and to undertake risk assessment, preventable occupational eye injuries have not been properly controlled. We hope to provide information for further development of preventive strategies.

We report the case of a newborn who suffered right atrial laceration during delivery. To our knowledge, there has been no previous report of blunt injury causing right atrial laceration with hemopericardium complicated by cardiac tamponade in the perinatal period.

Esophageal injury following blunt trauma to chest is an extremely rare event, with only a limited number of cases being reported in the world literature. We report a case of perforation of the lower thoracic esophagus following a crush injury to the chest in a 14 year old child. An appropriately placed chest drain and decompression gastrostomy resulted in complete resolution of the esophageal leak within four weeks. This case report demonstrates that a conservative approach to lower thoracic esophageal perforations can be carried out successfully without the added morbidity of thoracotomy and risks of direct repair.

Two patients who sustained severe blunt injury to the pelvis without external injury to the upper abdomen or lower chest, yet who were found to have a ruptured solid upper abdominal viscus, are reported. The first patient on delayed arrival revealed clinical features suggestive of intra-abdominal bleeding and was found to have a grade 3 ruptured spleen. With the second patient, upper abdominal injury (in this instance, a pancreatic laceration) was not initially suspected owing to the absence of clinical evidence of injury to the abdomen. It is postulated that both the splenic and pancreatic injuries were the result of a shockwave propagated through the abdomen following the severe external impact to the pelvis.

Adnexal torsion is an uncommon gynecological emergency which mostly occurs during productive ages and in adnexa with mass-increasing pathology or anatomical abnormality. We reported the first known case of torsion of a normal adnexa after a sport-related blunt abdominal trauma in a pre-pubertal girl. Adnexal torsion can happen in a pre-pubertal girl with normal adnexa. Common laboratory examinations provide little help and image studies can be suggestive but often not diagnostic. Early gynecological or surgical consultation is recommended in the context of a high level of clinical suspicion. Early surgical treatment is well codified and should be conservative by laparoscopy as possible.

We describe the case of a 15 year old boy who presented with generalised abdominal pain following a seemingly minor collision at weekend soccer. Investigation revealed a grade IV pancreatic injury that was subsequently managed with pancreatic stent insertion by endoscopic retrograde cholangiopancreatography (ERCP) and total parenteral nutrition (TPN) prior to recommencing low fat diet 10 days post-injury. Keywords: Trauma, Blunt injury, Pancreas, Non-operative

The clinical features of tracheal injury include hoarseness, subcutaneous emphysema and edema, and bruising of the neck. Patients with tracheal injury may present with minimal signs that are easily overlooked. The priority in treating such patients is to appropriately identify the tracheal anatomy before further treatment is administered. In this case, a male patient aged 17 years was injured over the first tracheal ring while riding a motorcycle. His stable condition obscured pathognomonic signs of complete cervical tracheal transection, which caused an unnecessary delay in treatment. In a case such as ours, the application of high resolution computed tomography (CT), as an adjuvant to bronchoscopy is important. If tracheal transection is suspected, the proximal and distal ends of the trachea might be not on the same axis and traditional laryngoscopy should not be performed in haste. A CT virtual bronchoscopic evaluation can provide great accuracy when analyzing the central and segmental bronchi, and can prevent a delayed diagnosis of complete tracheal transection. If the diagnosis is still not definite, then diagnostic bronchoscopy and intubation at the operating room is recommended.

Blunt carotid injury (BCAI) is an increasingly recognised entity in trauma patients. Without a prompt diagnosis and a proper treatment, they can result in devastating consequences with cerebral ischaemia rate of 40–80% and mortality rate of 25–60%. Several applied screening protocols and continuously improving diagnostic modalities have been developed to identify patients with BCAI. The appropriate treatment of BCAI still remains controversial and strictly individualised. Besides anti-thrombotic/anticoagulation therapy and surgical intervention, continuously evolving endovascular techniques emerge as an additional treatment option for patients with BCAI. We provide an update on blunt carotid trauma, emphasising the role of endovascular approaches.

Background Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. In this study, we present our 11-year experience in the management and clinical outcome of 888 chest trauma cases as a result of blunt and penetrating injuries in our university hospital in Damascus, Syria. Methods We reviewed files of 888 consequent cases of chest trauma between January 2000 and January 2011. The mean age of our patients was 31 ± 17 years mostly males with blunt injuries. Patients were evaluated and compared according to age, gender, etiology of trauma, thoracic and extra-thoracic injuries, complications, and mortality. Results The leading cause of the trauma was violence (41%) followed by traffic accidents (33%). Pneumothorax (51%), Hemothorax (38%), rib fractures (34%), and lung contusion (15%) were the most common types of injury. Associated injuries were documented in 36% of patients (extremities 19%, abdomen 13%, head 8%). A minority of the patients required thoracotomy (5.7%), and tube thoracostomy (56%) was sufficient to manage the majority of cases. Mean hospital LOS was 4.5 ± 4.6 days. The overall mortoality rate was 1.8%, and morbidity (n = 78, 8.7%). Conclusions New traffic laws (including seat belt enforcement) reduced incidence and severity of chest trauma in Syria. Violence was the most common cause of chest trauma rather than road traffic accidents in this series, this necessitates epidemiologic or multi-institutional studies to know to which degree violence contributes to chest trauma in Syria. The number of fractured ribs can be used as simple indicator of the severity of trauma. And we believe that significant neurotrauma, traffic accidents, hemodynamic status and GCS upon arrival, ICU admission, ventilator use, and complication of therapy are predictors of dismal prognosis.