Blunt cardiac trauma is diagnosed in less than 10% of trauma patients and covers the range of severity from clinically insignificant myocardial contusions to lethal multi-chamber cardiac rupture. The most common mechanisms of injury include: motor vehicle collisions (MVC), pedestrians struck by motor vehicles and falls from significant heights. A severe complication from blunt cardiac trauma is cardiac chamber rupture with pericardial tear. It is an exceedingly rare diagnosis. A retrospective review identified only 0.002% of all trauma patients presented with this condition. Most patients with atrial rupture do not survive transport to the hospital and upon arrival diagnosis remains difficult. We present two cases of atrial and pericardial rupture. The first case is a 33-year-old female involved in a MVC, who presented unresponsive, hypotensive and tachycardic. A left sided hemothorax was diagnosed and a chest tube placed with 1200 mL of bloody output. The patient was taken to the OR emergently. Intraoperatively, a laceration in the right pericardium and a 3 cm defect in the anterior, right atrium were identified. Despite measures to control hemorrhage and resuscitate the patient, the patient did not survive. The second case is a 58-year-old male involved in a high-speed MVC. Similar to the first case, the patient presented unresponsive, hypotensive and tachycardic with a left sided hemothorax. A chest tube was placed with 900 mL of bloody output. Based on the output and ongoing resuscitation requirements, the patient was taken to the OR. Intraoperatively, a 15 cm anterior pericardial laceration was identified. Through the defect, there was brisk bleeding from a 1 cm laceration on the left atrial appendage. The injury was debrided and repaired using a running 3–0 polypropylene suture over a Satinsky clamp. The patient eventually recovered and was discharged home. We present two cases of uncontained atrial and pericardial rupture from blunt cardiac trauma. Contained ruptures with an intact pericardium present as a cardiac tamponade while uncontained ruptures present with hemomediastinum or hemothorax. A high degree of suspicion is required to rapidly diagnose and perform the cardiorrhaphy to offer the best chance at survival.

Gallbladder volvulus (GV) is an axial twisting of the gallbladder (GB). If not treated on time, this condition has a mortality up to 6%. It is usually diagnosed intraoperatively, because it can mimic a typical acute cholecystitis. An 81‐year‐old female patient presented with an acute onset of right upper quadrant pain accompanied with nausea. The patient was admitted to receive treatment for acute cholecystitis after the findings of ultrasound imaging. Robotic‐assisted cholecystectomy was the approach chosen. GV was diagnosed after initial diagnostic laparoscopy. Cholecystectomy was performed uneventfully. Indocyanine green fluorescence was used to assess the biliary anatomy. The postoperatory course went uneventful. The patient was discharged home on postoperatory day 2.

A Randomized Controlled Trial on Intra-Abdominal Irrigation during Emergency Trauma Laparotomy; Time for Yet Another Paradigm Shift

Telemedicine (TM) has emerged as a transformative tool in trauma care, enabling remote consultation and guidance for healthcare providers, especially in resource-limited settings. This review evaluates TM's effectiveness in trauma care by assessing its impact on clinical outcomes, mortality, injury severity, and healthcare resource utilization. A systematic literature search was performed across PubMed, Google Scholar, Science Direct, ProQuest, Medline, and Web of Science and included randomized controlled trials and cohort studies involving adult trauma patients. Extracted data encompassed demographics, injury characteristics, and clinical outcomes. Analysis of 25 studies (n = 45,097 patients) revealed that TM was associated with higher Injury Severity Scores (ISS), likely due to improved detection and documentation of severe injuries through specialist input. Increased blood transfusion rates were observed, which may reflect more accurate triage and timely intervention facilitated by TM, though confounding factors (e.g., case mix) cannot be ruled out. Both patient and physician satisfaction rates were high. However, TM demonstrated no statistically significant effect on mortality (p > 0.05), transfer times, or emergency department (ED) utilization-a finding consistent with some prior studies but warranting further investigation, given the heterogeneity in protocols. TM enhances trauma care coordination in rural and underserved areas by improving access to specialist expertise, which may explain observed benefits like higher ISS detection and transfusion rates. However, its inconsistent impact on mortality and resource use underscores the need for standardized implementation protocols. Future integration should optimize TM workflows (e.g., reducing decision delays) and pair them with targeted resource allocation to maximize outcomes.