Complex Organ Injury Management in Abdominal Trauma: Case of a Heavy Iron Plate Accident

BACKGROUND Open injury of multiple organs in the chest and abdomen, such as the colon, duodenum, kidney, liver and diaphragm, is relatively rare. The rescue of such a patient is difficult, and the results are often unsatisfactory. It is also a challenge for the hospital and doctors. CASE REPORT A 44-year-old man was injured by a heavy falling iron plate on a construction site. The right side of his abdomen was severely lacerated, with a 30-40-cm long wound and multiple exposed abdominal organs. He was send to our Emergency Department within 2 h, with gauze covering the wound. The relevant examinations were completed immediately, and emergency surgery was performed in a multidisciplinary manner. During surgery, we found that the hepatic flexure of colon, right kidney, and descending duodenum was ruptured, there was mild laceration to the liver, and the right diaphragm was ruptured, with hemopneumothorax. The right kidney, right half colon, gallbladder, duodenum, and part of the head of the pancreas were removed. Ileostomy was done, and gastric-intestine, biliary-intestine, and pancreas-intestine anastomosis were done. The liver and diaphragm were repaired. The patient was discharged after 23 days in hospital, without any serious complications. One year later, the ileostomy was closed in our hospital. CONCLUSIONS Multidisciplinary collaboration and adherence to evidence-based guidance are important for rescuing patients with severe chest and abdominal trauma.