Presentation
140kph car crash.
Patient Data
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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.
Case Discussion
Laparotomy:
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.