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Case Reports
. 2018 Apr;21(2):118-121.
doi: 10.1016/j.cjtee.2017.10.004. Epub 2018 Feb 20.

Forty hours with a traumatic carotid transection: A diagnostic caveat and review of the contemporary management of penetrating neck trauma

Eugene Ng  1 , Ian Campbell  2 , Andrew Choong  2 , Allan Kruger  2 , Philip J Walker  2
Affiliations
Case Reports

Forty hours with a traumatic carotid transection: A diagnostic caveat and review of the contemporary management of penetrating neck trauma

Eugene Ng et al. Chin J Traumatol. 2018 Apr.

Erratum in

Abstract

Although penetrating neck trauma (PNT) is uncommon, it is associated with the significant morbidity and mortality. The management of PNT has changed significantly over the past 50 years. A radiological assessment now is a vital part of the management with a traditional surgical exploration. A 22 years old male was assaulted by a screwdriver and sustained multiple penetrating neck injuries. A contrast CT scan revealed a focal pseudoaneurysm in the left common carotid artery bulb. There was no active bleeding or any other vascular injuries and the patient remained haemodynamically stable. In view of these findings, he was initially managed conservatively without an open surgical exploration. However, the patient was noted to have an acute drop in his hemoglobin count overnight post injury and the catheter directed angiography showed active bleeding from the pseudoaneurysm. Surgical exploration 40 hours following the initial injury revealed a penetrating injury through both arterial walls of the left carotid bulb which was repaired with a great saphenous vein patch. A percutaneous drain was inserted in the carotid triangle and a course of intravenous antibiotics for five days was commenced. The patient recovered well with no complications and remained asymptomatic at five months followup.

Keywords: Assessment penetrating neck trauma; Investigation penetrating neck trauma; Management penetrating neck trauma; Penetrating neck trauma.

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Figures

Fig. 1
Fig. 1
Anatomical description of the location of penetrating neck injuries. Source: Van Waeset al..
Fig. 2
Fig. 2
Computer tomography angiography of the neck demonstrates a left common carotid artery pseudoaneurysm.
Fig. 3
Fig. 3
A 3-D reconstruction of catheter based carotid angiography reveals focal pseudoaneurysm of the carotid bulb (white arrow).
Fig. 4
Fig. 4
Intraoperative photo depicts carotid transection in the left common carotid artery bulb (black arrows).
Fig. 5
Fig. 5
Management algorithm of PNT following primary survey.
See this image and copyright information in PMC

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