TY - JOUR T1 - Case of horseshoe kidney injury treated with simultaneous damage control operation and endovascular therapy in a hybrid emergency system (HERS) JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2022-000885 VL - 7 IS - 1 SP - e000885 AU - Tomoki Kanda AU - Kaori Ito AU - Taichiro Tsunoyama AU - Tsuyoshi Nagao AU - Naoto Morimura Y1 - 2022/03/01 UR - http://tsaco.bmj.com/content/7/1/e000885.abstract N2 - A 14-year-old boy who jumped from the 12th floor was brought to our emergency department and directly admitted to the hybrid emergency room system (HERS). The HERS is a trauma resuscitation room equipped with a CT scanner, fluoroscopy unit, and operating room setup (figure 1).Figure 1 The HERS at Teikyo University. A CT scanner and fluoroscopy instrument are installed in the trauma resuscitation room, which functions as an operating room and an angio-suite. HERS, hybrid emergency room system.His vital signs at admission were as follows: Glasgow Coma Scale score, 6 (E1V1M4); heart rate, 132 bpm; blood pressure, unmeasurable; respiratory rate, 18 breaths per minute; SpO2, 89% ; and body temperature, 34.6°C.The extended focused assessment with sonography for trauma (eFAST) was negative. The arterial blood gas analysis showed a pH of 7.0 and lactic acid level of 14.1 mmol/L. Laboratory tests revealed fibrinogen level 139 mg/dL.The patient was intubated. Blood transfusion was initiated. The resuscitative balloon occlusion of the aorta (REBOA) was inserted in Zone I under fluoroscopy. The patient’s systolic blood pressure improved to 75 mm Hg. Whole-body CT (WBCT) with an intravenous contrast agent was performed.WBCT showed a horseshoe kidney (HSK) injury. Active extravasation of the contrast agent from the lower pole of the left wing of the HSK surrounded by retroperitoneal hematoma was observed (figure 2A–C). Five aberrant arteries from the aorta were … ER -