American Journal of Emergency Medicine (2008) 26, 841.e3–841.

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Case Report

Damage control in the transection of carotid

artery—a case report

Abstract

Transection of the carotid artery is very rare in Taiwan

owing to tight gun control. Most carotid artery injuries are
caused by penetration wounds as a result of stabbing or
shooting. The total transection of internal and external
common arteries is very rarely encountered, and most
surgeons lack experience of this intervention. We present a
very rare patient who had his right neck cut caused by a flying
piece of sheet metal during a typhoon. The case was sent to
our emergency department without any vital signs. Intubation
was performed into the perforation of larynx with aggressive
resuscitation. The patient regained his heart rate and blood
pressure after several minutes of cardiopulmonary resuscita-
tion. Then he was sent to operating room, where tracheost-
omy was performed and bleeding was controlled by ligation
of all bleeding arteries including internal and external carotid
arteries. Two days later, the patient died, however. We
reviewed the literatures and discussed the case.
A 28-year-old male patient who has been injured during
a typhoon was sent to our emergency department (ED)
without vital signs and was dead on arrival. Upon arrival,
he was unconscious, and his pulse and blood pressure could
not be measured. Clinically, he presented poor peripheral
perfusion with pale, cool extremities, and oliguria. His right
neck had been cut by a flying sheet metal and had been
compressed by gauzes with elastic bandage by the
emergency medical technicians. Cardiopulmonary resusci-
tation was performed immediately with aggressive resusci-
tation after direct insertion of endotracheal tube into the
perforation of larynx. After several minutes, his heart
started beating and blood pressure was elevated. During
exploration of the wound to his neck, a life-threatening
transection injury above the bifida of the common carotid
artery was found with mass active hemorrhage (Fig. 1). To
control the bleeding, the trauma surgeon clamped the 2
ends of external and internal carotid artery with other small
active bleeding points by forceps. The patient was
immediately transferred to the operating room for the
vascular and larynx repair.
Fig. 1 The neck wound extended from zones I to II with internal
and external carotid transection (white arrows) combined with other
vessel injuries and laryngeal perforation.
In the operating room, tracheostomy was performed, and
the clamped arteries were immediately ligated due to active
leaking from the wound and relative hypotension of the
patient. Laryngeal perforation was repaired, and all
intervention was done within 1 hour. The patient was
sent to intensive care unit (ICU) for further management. In
ICU, the patient's blood pressure elevated after resuscita-
tion, and his bilateral pupils also had light reflex in the first
12 hours. The wound leaked extensively if the blood
pressure was elevated. Then, his right pupil dilated, and
brain computed tomography showed right brain edema with
left hemisphere hemorrhage (Fig. 2). Two days after, his
blood pressure dropped, and he died as a result of central
failure [1,2].
Injury to the artery distal to the bifida of common carotid
artery is a rare event, with a poor prognosis and high
mortality. Penetrating injuries to the carotid and vertebral
arteries account for only 3% and 0.5%, respectively, of
arterial injuries treated in other trauma centers [3,4].
Ramadan et al reported that injuries to the common carotid
artery overall mortality and stroke rates were 17% and 28%,
respectively. Patients presenting with coma or shock had a
particularly poor prognosis (50% and 41% mortality,

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