Resection for Chronic Hepatic Abscess due to Infected Embolization Coils After Liver Injury

Liver injuries after blunt abdominal trauma are very common. Non-operative approaches to management are now the standard of care for many patients with up to and including grade V liver injuries. However, the long-term complications associated with coil embolization can be challenging to manage. We present the case of a 29-year-old male who presented with a chronic liver abscess which contained the coils following embolization of a grade IV liver injury and the subsequent transhepatic embolization of the pseudoaneurysm. In addition, the patient developed a fistula draining the abscess through the previously placed drain site that traversed the diaphragm. A multidisciplinary discussion was held between trauma surgery, hepatobiliary surgery, thoracic surgery, and interventional radiology to discuss the best treatment plan. The patient subsequently underwent liver resection, fistula tract resection, and diaphragm repair. This case presents a definitive management strategy for these complex patients.

Severe Thoracic Vertebral Spine Injury as a Complication of Component of Cardiopulmonary Resuscitation

Chest compression has been a component of cardiopulmonary resuscitation (CPR) since 1960. Performance of high-quality CPR is critical for survival; however, chest compressions are traumatic and may result in injuries such as rib and sternal fractures. Spinal fractures have rarely been reported. We present a case of a 69-year-old male who suffered a cardiac arrest at home. He underwent 16 minutes of CPR with manual chest compressions, and no electrical shock and medications with return of spontaneous circulation (ROSC). Computed tomography scan showed unstable fracture of T9-T10. The patient was transferred to our Level I trauma center for continued post-arrest management and neurosurgical evaluation. An MRI confirmed the unstable spinal fracture which would have required surgical stabilization. The patient remained comatose, thus he was transitioned to comfort measures and expired. Spinal injuries following CPR are rare but should be considered in the post-arrest management stage. Computed tomography scan is the ideal screening modality.