Blood in uterovesical and rectovesical pouch in trauma patient

Case contributed by Dr Dayu Gai

Presentation

This 19 year old female was involved in a motor vehicle accident. She had a tender abdominal wound and right hip. A CT abdomen was performed as part of a CT trauma series.

Patient Data

Age: 19
Gender: Female

Conclusion

  • In the right iliac fossa multiple locules of gas and subcutaneous stranding mark the site of the clinically apparent groin wound.
    • Locules of gas extend inferiorly adjacent to the psoas muscle and superiorly in extra peritoneal locations. At the iliac crest underlying the wound, there is an apparent localised defect in the contour of the peritoneal cavity and anterior abdominal wall musculature when compared to the contralateral side. There is herniation of extraperitoneal fat and caecum into this defect.
  • No definite peritoneal breach is identified, nor intraperitoneal free gas, however the possibility of peritoneal intrusion at this site is raised.
  • Within the pelvis, there is a moderate amount of blood.
  • There is stranding in the lower small bowel mesentery, raising the possibility of an occult bowel injury.

Case Discussion

This patient has had significant traumatic injury to the groin. Note the hypodense densities representing locules of air trapped within the right iliac fossa. 

Also note the heterogeneous fluid surrounding the bladder and sitting dependently within the pelvis. It is likely that the initial traumatic event caused trauma to the lower small bowel mesentery, which has tracked down from the peritoneum to sit within the pelvis. It is lying dependently in the uterovesical pouch and the rectouterine pouch.

Case contributed by A/Prof. Pramit Phal.

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Case information

rID: 34090
Case created: 4th Feb 2015
Last edited: 24th Nov 2015
Inclusion in quiz mode: Included

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