Abdominal multitrauma - pediatric

Case contributed by Assis Prof Faeze Salahshour

Presentation

A young girl accidentally impinged between her father's car and parking wall while quietly playing.

Patient Data

Age: 5 years
Gender: Female

Liver laceration with about 2 cm depth and 4 cm length is noted in the segment VII, without any parenchymal or subcapsular hematoma or active bleeding (grade II AAST liver injury scale). Several lacerations up to 4 cm in depth are also seen in the medial aspect of the spleen (grade III AAST spleen injury scale). The upper pole and lower half of the right kidney seem devascularized, multiple lacerations more than 1 cm in depth are seen in the mid pole of the right kidney as well as a small perinephric hematoma. On delayed images, extravasation of excreted contrast from the junction of lower major calyx to the pelvis is seen. No active bleeding is depicted (grade IV AAST kidney injury).

Annotated image

The red arrow points to the hepatic laceration. The blue shows the spleen lacerations. The black and yellow arrows point to the kidney lacerations and perinephric hematoma, respectively. The green arrow depicts infarcted lower renal pole and the purple points to excreted contrast extravasation.

Case Discussion

The child underwent conservative management for the hepatic and splenic injuries. A double j catheter inserted on the right side because of persistent urinary leakage on follow up CT during her admission. She was discharged in a good condition.

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Case information

rID: 80834
Published: 13th Aug 2020
Last edited: 14th Aug 2020
Inclusion in quiz mode: Included
Institution: Tehran University of Medical Sciences (TUMS)

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