Presentation
Road traffic accident polytrauma patient came to the casualty with severe abdominal trauma and multiple injuries.
Patient Data
Organised haematoma of high contrast densities within, shows blood pool matching in different phases, denoting active bleeding. This is noted at the region of the small bowel mesentery and reaching the mesentery of the transverse colon. It measures about 71 x 49 x 47 mm and increases in size in delayed images. The picture is consistent with mesenteric injury/tear with active bleeding.
Splenic upper pole small laceration <3 cm with intra-parenchymal haematoma <5 cm, consistent with grade II splenic injury.
Mild haemoperitoneum.
Abdominal wall contusions, soft tissue oedema, and ventral hernia with omentum and a short segment of the transverse colon protruding through it, consistent with post-traumatic hernia.
Fracture in the posterior aspect of the right acetabulum.
Operative notes:
A mid-line incision was made, and the abdomen was opened in layers. Muscular tears with traumatic hernia at the level of the umbilicus showed herniation of omentum and bowel, with active bleeding from the muscles. Haemoperitoneum was estimated to be about 1 litre. Exploration of the small bowel/mid jejunum revealed a 3 cm mesenteric tear with active bleeding. Ligation of the bleeder and repair of the mesenteric tear were performed. There was bleeding from the transverse colon mesentery, and ligation and repair were undertaken. A small splenic haematoma with no active bleeding was observed. The liver, stomach, and the rest of the large bowel were normal. The diaphragm was intact.
Case Discussion
Case of a road traffic accident polytrauma patient with multiple injuries, as confirmed by operative findings, including a mesenteric tear in both small and large bowel, splenic injury, post-traumatic ventral hernia, fractures, and mild haemoperitoneum.
I would like to express my gratitude to Dr. El Sadiq Elmukashfi Ahmed, Dr. Md Shahriar Sabbir, SQH Surgery Department, and Dr. Hitham Mohamed Abozied, SQH Orthopaedic Department, for their assistance in this case study, providing informative operative notes.