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140kph car crash.
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Transverse band of sub-cutaneous fat stranding across the lower anterior abdomen.
Small volume hemoperitoneum.
Mesenteric thickening, stranding, and fluid across the lower abdomen.
Fractured anterosuperior corner of L3.
mesenteric tears and vascular injuries
infarcted terminal ileum necessitating partial ileocolectomy
muscle tear of the rectum treated by high anterior resection
PR bleeding continued for 4 days and then settled.
Vascular, bowel and mesenteric injuries are often missed or under-diagnosed. Intermittent hemorrhage from vascular injuries is common. The terminal ileum is one of the relatively fixed areas of the bowel which are prone to injury.
Transverse subcutaneous fat-stranding is the radiological corollary of the seatbelt sign. The small L3 fracture is an indicator of the force of the trauma.
- Patlas M, Dreizin D, Menias C et al. Abdominal and Pelvic Trauma: Misses and Misinterpretations at Multidetector CT: Trauma/Emergency Radiology. Radiographics. 2017;37(2):703-4. doi:10.1148/rg.2017160067 - Pubmed