Lesser sac hematoma - post-traumatic)

Case contributed by Dr Husam Hussein Yaseen

Presentation

Patient with a history of upper abdomen blunt trauma presented on the next day with gradually increasing abdominal pain.

Patient Data

Age: 25 years
Gender: Male

A large hyperdense hematoma is occupying the lesser sac displacing the adjacent organs with multiple minor hepatic parenchymal lacerations and hyperdense free abdominal fluid (hemoperitoneum).

A blush of contrast on the medial side of lesser sac hematoma near a small hepatic laceration suggests a site of active bleeding or pseudoaneurysm from small intrahepatic vessels. Further small laceration in liver segment 4b.

The bone and other solid abdominal organs are uninjured.

Case Discussion

Trauma, ruptured pancreatic or splenic artery aneurysm, coagulopathy and idiopathic lesser sac hematoma are the main differentials in such cases.

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