Polytrauma with left renal devascularization, pancreatic transection, splenic and hepatic lacerations

Case contributed by Dr Heather Pascoe

Presentation

MCA. Unrestrained passenger. Severe back and upper abdominal pain.

Patient Data

Age: 20 years
Gender: Female
  1. Devascularisation of the left kidney secondary to transection of the left renal artery. Suspicion for active haemorrhage within the posterior aspect of the left kidney.
  2. Pancreas body laceration, possibly transection, at risk for pancreatic duct injury.
  3. Splenic and left lobe of liver lacerations. No active contrast extravasation identified at these lacerations. There is an associated retroperitoneal haematoma that tracks into the lienorenal and gastrosplenic ligaments.
  4. Small right haemothorax.
  5. Fractures of the right transverse processes of T7, T8 and T9, as well as a fracture through the right posterolateral superior corner of the T10  vertebral body.

Case Discussion

CT findings of pancreatic injury can be subtle initially however early diagnosis is critical in reducing morbidity and mortality. Direct findings of pancreatic injuries include: enlargement of the pancreas; a laceration (focal linear non-enhancement); comminution (fracture) and inhomogeneous enhancement. Secondary findings include: peripancreatic fluid and stranding; fluid between the splenic vein and pancreas; peripancreatic haemorrhage; thickening of the left anterior pararenal fascia and injuries to adjacent structures.

Devascularisation of the kidney is a AAST Grade 5 injury. 

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Case information

rID: 33610
Case created: 18th Jan 2015
Last edited: 13th Feb 2018
Inclusion in quiz mode: Included

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