Presentation
Fall from a bike in the woods after attempting a stunt. Pain to mid-abdomen. Tender and tense. Haemodynamically unstable with hypotension and tachycardia.
Patient Data
Underinspired and rotated.
Lungs are well expanded with minor airspace opacification, but no confluent consolidation or collapse, no pneumothorax or effusion. No fracture.
Large right-sided liver laceration predominantly affecting segments VII and VIII. The laceration extends to the hilum.
Portal vein contrast-filling is normal. The extrahepatic hepatic artery is normal, but as the intra-hepatic artery divides, there is a blush of contrast indicating vascular injury and extravasation.
Widespread intraperitoneal free fluid with high density material (blood) in the right paracolic gutter. No other solid-organ injury or bony fracture.
Small left pneumothorax.
Case Discussion
Solid organ trauma is not common in children but does occur after significant blunt abdominal trauma. As in the adult population, it is important to determine the extent of the laceration and whether there is associated vascular or biliary injury. It is also important to determine whether there is associated duodenal or mesenteric injury (these are common in children, but less common in adults).
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