Presentation
Stabbing. Free fluid around liver on FAST.
Patient Data
Moderate hemoperitoneum as well as large mesenteric hemorrhage. No definite area of active contrast extravasation.
Small pneumoperitoneum suggesting bowel wall perforation, probably involving the transverse colon. Marked fecal loading and distended colon, transverse colon measuring 5.5cm.
No solid organ injury identified. Collapsed IVC in keeping with hypovolemia. Dependent atelectasis in the lung bases.
Red arrows indicate position of mesenteric hematoma.
Case Discussion
FAST scans are well established in trauma centers, having replaced diagnostic peritoneal lavage for assessment of hemoperitoneum. Studies have shown relatively high sensitivity (~90%) and specificity (~95%) but this will obviously depend on operator training and experience.