Presentation
A 70 year old female transferred from a private facility for investigation of abdominal pain 2 weeks post total knee replacement. On initial examination she was found to have a tense, painful abdomen with guarding. She was referred for surgical review and plain films were obtained.
Patient Data
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Plain films showed increased bowel gas but no evidence of obstruction, constipation, mass or perforation.
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The surgical consultant examined the patient & was concerned about a palpable mass ordered a CT.
There is a large hematoma within the left anterior abdominal wall, involving the rectus abdominis, and the internal and external oblique muscles. This measures approximately 9cm x 20.9cm x 16.7cm. This is heterogeneous in attenuation likely due to presence of fibrin and blood products. There is contrast extravasation indicating active bleeding, within the superior abdominal wall (2-32 and 4-12), and within the mid abdominal wall posteriorly (2-46 and 4-22). Stranding is seen surrounding the hematoma.
The multilobulated cystic lesion involving the head and uncinate process of the pancreas appears unchanged in size since last scan, measuring approximately 51mm x 48mm x 52mm. The rest of the pancreas defines normally.