Staged management of severe polytrauma with pericardial and diaphragmatic rupture and open pelvic ring injury: a case report with literature review
Abstract
Introduction High-energy polytrauma demands decisive, parallel actions within a narrow window. Using an integrated Emergency Medical Services System, we enabled unified coordination for synchronous damage-control surgery (DCS) and report a representative case with lessons. Case presentation A 60-year-old woman run over by a truck arrived 4 hours after injury in decompensated hemorrhagic shock (pH 7.03, base excess −9.4 mmol/L, lactate 6.4 mmol/L on norepinephrine) with positive extended focused assessment with sonography for trauma, evisceration with heavy perineal contamination, and extensive lower-limb degloving. computed tomography showed left diaphragmatic and probable pericardial rupture, active hepatic bleeding, an open pelvic ring, and additional fractures. Under integrated team leadership, three teams performed synchronous, life-threatening-prioritized DCS: laparotomy with repair of the pericardium and diaphragm; small bowel resection with primary anastomosis; hemorrhage control via bilateral internal iliac artery ligation and hepatic hemostasis; wide debridement with negative-pressure wound therapy; and left hip disarticulation. Despite initial stabilization in the emergency ICU, she developed severe acute respiratory distress syndrome, septic shock from persistent contamination, and multiple organ dysfunction syndrome, resulting in death. Discussion Synchronous multiteam surgery within an integrated system shortened time to hemostasis and contamination control and…
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