Abdominal multitrauma - devascularised kidney and liver, spleen and pancreatic lacerations

Case contributed by Dr Craig Hacking

Presentation

Unrestrained passenger in MVA. Back and abdominal pain.

Patient Data

Age: 18
Gender: Female

CT Angiogram Thoracic Aorta

No traumatic aortic injury or mediastinal haematoma. No pericardial effusion. There is a small right pleural collection that does not demonstrate water attenuation. There is minor bilateral dependent lung change. No focal region of consolidation. No pneumothorax. No rib or sternal fracture.

CT Abdomen / Pelvis

There is no perfusion of the left kidney. The left renal artery demonstrates normal opacification within its proximal 7 mm. There is however immediate truncation of the artery at a point of retroperitoneal haematoma. This haematoma lies immediately posterior to a laceration of the body of the pancreas. There are only small contrast opacified vessels identified within the left kidney. Within the posterior aspect of the left kidney, there is a region of apparent contrast extravasation that demonstrates increased spread and size increase on the delayed scan. Remote from the left renal hilum, no large left perinephric collection. On the delayed phase, there is minor contrast opacification of the left renal collecting system without evidence of injury to the left collecting system.

The right kidney perfuses normally. The right renal artery has an unremarkable appearance. No evidence of traumatic injury to the right collecting system.

There is a laceration through the body of the pancreas that extends completely from its anterior to posterior borders. There is also an 11 mm laceration through the medial border of the spleen that does not extend to the splenic hilum. There is associated retroperitoneal haematoma that lies within the lienorenal and gastrosplenic ligaments, as well as lying superior to the pancreas. No free intraperitoneal fluid or gas.

There is a laceration through the lateral segments of the left lobe of the liver. The hepatic veins, porta hepatis and intrahepatic IVC are not involved. Bilateral adrenal glands have an unremarkable appearance. Previous cholecystectomy. Common bile duct measures 8 mm. The ostia of the coeliac trunk, SMA and IMA are unremarkable. The small and large bowel enhance normally, with no abnormal regions of abnormal wall thickening identified.

Retroverted uterus.

No pelvic fracture.

CT Thoracic and Lumbar Spine

There are fractures through the right transverse processes of T7, T8 and T9. There is a fracture through the right posterolateral superior corner of the T10 vertebral body that does not extend into the adjacent pedicle.

No lumbar spine fracture. Failure of fusion of the posterior elements of S1 noted.

Conclusion

  1. Devascularisation of the left kidney secondary to transection of the left renal artery. Suspicion for active haemorrhage within the posterior aspect of the left kidney.
  2. Pancreas body laceration, possibly transection, at risk for pancreatic duct injury.
  3. Splenic and left lobe of liver lacerations. No active contrast extravasation identified at these lacerations. There is an associated retroperitoneal haematoma that tracks into the lienorenal and gastrosplenic ligaments.
  4. Small right haemothorax.
  5. Fractures of the right transverse processes of T7, T8 and T9, as well as a fracture through the right posterolateral superior corner of the T10 vertebral body.
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Case Information

rID: 34984
Case created: 18th Mar 2015
Last edited: 4th Feb 2016
Inclusion in quiz mode: Included

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