Pancreatic transection with liver, renal and colonic lacerations

Case contributed by Dr Craig Hacking

Presentation

MVA 100kpm into tree. Thorax vs steering wheel. Open left femoral fracture. Tender abdomen.

Patient Data

Age: 33
Gender: Male

Branching hypodensity extending from the gallbladder fossa anteriorly is consistent with a liver laceration. This approaches the anterior surface of the liver. Fluid within the gallbladder fossa. No perihepatic haematoma.

Linear hypodensity at the superior pole of the right kidney likely represents a laceration. Fat stranding around the right kidney.

Fat stranding and fluid surrounding the splenic flexure. Two small adjacent gas locules appear extraluminal - there is surrounding fluid and soft tissue stranding and these may be intramural in location. No definite adjacent bowel wall thickening. The remainder of the large and small bowel are within normal limits.

The tail of the pancreas is irregular and is surrounded by free fluid. Hypodensity through the neck of the pancreas that appears to extend all the way through. The portal vein opacifies normally.

Free fluid adjacent to the spleen measures 10HU in keeping with simple free fluid. Free fluid within the pelvis - the density is higher in the more dependent regions. This may represent a combination of fluid +/- blood.

The spleen opacifies normally, with no evidence of contusion or laceration. The adrenals and bladder are unremarkable.

No lumbar vertebral fracture or malalignment. No paravertebral haematoma.

No fracture of the pelvis, sacrum or proximal femora. The sacroiliac joints and pubic symphysis are not widened.

Conclusion

  • Right superior pole renal laceration with adjacent perinephric stranding.
  • Fluid and stranding around the splenic flexure and small locule of gas (possibly extra luminal), raises the suspicion of splenic flexure injury (contained). There is no free intraperitoneal gas.
  • Pancreatic body laceration, probably transection (pancreatic duct at high risk of injury).
  • Liver laceration extending from the gallbladder fossa. No perihepatic haematoma.
  • Free fluid in the pelvis - fluid +/- blood.

Case Discussion

Transverse colon laceration confirmed at laparotomy.

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Case Information

rID: 36883
Case created: 14th May 2015
Last edited: 15th Apr 2017
Tag: trauma
Inclusion in quiz mode: Included

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