Journal of Emergencies, Trauma, and Shock

LETTERS TO EDITOR
Year
: 2021  |  Volume : 14  |  Issue : 1  |  Page : 58--60

Successful observational management of a patient with blunt abdominal trauma with the traumatic vacuum phenomenon


Youichi Yanagawa, Hiroki Nagasawa, Kei Jitsuiki, Kazuhiko Omori 
 Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Japan

Correspondence Address:
Prof. Youichi Yanagawa
1129 Nagaoka, Izunokuni City, Shizuoka
Japan




How to cite this article:
Yanagawa Y, Nagasawa H, Jitsuiki K, Omori K. Successful observational management of a patient with blunt abdominal trauma with the traumatic vacuum phenomenon.J Emerg Trauma Shock 2021;14:58-60


How to cite this URL:
Yanagawa Y, Nagasawa H, Jitsuiki K, Omori K. Successful observational management of a patient with blunt abdominal trauma with the traumatic vacuum phenomenon. J Emerg Trauma Shock [serial online] 2021 [cited 2022 Sep 29 ];14:58-60
Available from: https://www.onlinejets.org/text.asp?2021/14/1/58/311794


Full Text



Dear Editor,

The high spatial and densitometric resolution of computed tomography (CT) means that it frequently shows gas in tissues. CT often detects gas degeneration of the intervertebral disk as the vacuum phenomenon (VP).[1] The VP is observed at locations that experience traumatic impact; thus, an analysis of the VP may be useful for elucidating the mechanism of injury.[2] We herein report a case involving a patient in whom the VP was detected in the intra-abdominal space after blunt abdominal trauma, which was successfully managed with observation.

The patient was a 26-year-old man who complained of pain in his right forehead, right chest, right abdomen, back, and both legs after falling from a collapsed stage. When the patient fell, a 2-cm bolt penetrated his right abdominal wall. He removed the bolt by himself. He had no relevant past or family history. On arrival, he was alert and his vital signs were stable. A physical examination showed contusional lacerated wounds on his right forehead and right abdomen [Figure 1], scrubbing wounds on both legs, and tenderness of the right chest and back. The right abdomen showed focal muscle guarding on palpation. Focused assessment with sonography for trauma, chest and pelvic roentgenography, and electrocardiography were all negative. Traumatic pan-CT demonstrated small areas of air density in the right subcutaneous tissue and intra-abdominal space, just under abdominal straight muscle without thickness of the bowel or ascites [Figure 2]. Focal exploration of the right abdominal wound did not show evidence of penetration into the intra-abdominal space. The contusional lacerations were sutured after irrigation. The areas of air density in the right intra-abdominal space were indicative of the traumatic VP without bowel injury; thus, the patient was admitted for observation. On the 2nd day, he started to eat and use analgesics after the confirmation of the passing of gas. On the 3rd day, he could walk after his pain was controlled and he was discharged on the 4th day.{Figure 1}{Figure 2}

To our knowledge, this is the first report describing the successful observational management of a patient with intra-abdominal gas due to traumatic VP. We previously experienced two surgically treated cases of intra-abdominal gas due to traumatic VP; both cases were surgically managed because they showed signs of peritoneal stimulation, which suggested bowel injury.[3],[4] However, in both cases, laparotomy revealed the absence of bowel injury. The abdominal wall injury showed the same reaction as the peritoneal stimulation sign on palpation. Accordingly, radiological findings of bowel injury, such as thickening bowel injury, fluid collection, and/or the dirty fat sign, might be necessary to indicate surgical intervention, when air density on CT suggests the traumatic VP.[5]

Blunt abdominal trauma may produce gas in the intra-abdominal space without bowel injury. Other findings of bowel injury on a radiological study might indicate the need for surgical intervention.

Acknowledgment

This work was supported in part by a Grant-in-Aid for Special Research in Subsidies for ordinary expenses of private schools from The Promotion and Mutual Aid Corporation for Private Schools of Japan.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

References

1Lardé D, Mathieu D, Frija J, Gaston A, Vasile N. Spinal vacuum phenomenon: CT diagnosis and significance. J Comput Assist Tomogr 1982;6:671-6.
2Yanagawa Y, Ohsaka H, Jitsuiki K, Yoshizawa T, Takeuchi I, Omori K, et al. Vacuum phenomenon. Emerg Radiol 2016;23:377-82.
3Mishima K, Omori K, Ohsaka H, Takeda J, Ishikawa K, Obinata M, et al. A case of the vacuum phenomenon as a mechanism of gas production in the abdominal wall. Am J Emerg Med 2015;33:863.e1-2.
4Oode Y, Jitsuiki K, Yoshizawa T, Ohsaka H, Ishikawa K, Obinata M, et al. Vacuum Phenomenon as a Mechanism of Gas Production in the Abdominal Wall. J Emerg Med 2017;52:e51-e52.
5Iaselli F, Mazzei MA, Firetto C, D'Elia D, Squitieri NC, Biondetti PR, et al. Bowel and mesenteric injuries from blunt abdominal trauma: A review. Radiol Med 2015;120:21-32.