Staged management of severe polytrauma with pericardial and diaphragmatic rupture and open pelvic ring injury: a case report with literature review.

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 stabilized physiology. Shortcomings included primary anastomosis without diversion under shock and heavy contamination and inadequate source control due to persistent bioburden from extensive soft-tissue loss despite staged debridement and negative-pressure wound therapy. Findings support early multidisciplinary coordination, default diversion in high-risk settings, and early soft-tissue coverage or temporary reconstruction. These observations are consistent with contemporary reports emphasizing time-compressed damage control, diversion in high-risk bowel injury, and early coverage or staged reconstruction in open pelvic injuries.

CONCLUSION: A three-team synchronous strategy can expedite life-saving stabilization in high-energy polytrauma; however, extensive soft-tissue loss and heavy contamination warrant diversion and early coverage to reduce infectious complications.