Mesenteric hematoma from penetrating trauma

Case contributed by RMH Core Conditions
Diagnosis certain


Stabbing. Free fluid around liver on FAST.

Patient Data

Age: 30 years
Gender: Female

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.

Annotated image

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. 

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