Presentation
Fall of mountain bike followed by collapse; handlebar injury to abdomen. Hypotensive. Chest clear. GCS 15.
Patient Data
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Hemoperitoneum with large splenic laceration and dissociation of the poles (best seen on oblique reformat). Hyperdense material at the free edge of the superior spleen suggesting active bleeding.
Trace fluid around the left kidney, but no other definite solid organ injury (normal liver, pancreas, adrenals and right kidney allowing for phase of contrast. Some free fluid / contusion around central mesentery but normal bowel enhancement.
Normal major vessel enhancement.
No fractures.
No chest abnormality (not uploaded).
Case Discussion
Significant blunt injury to the abdomen with high grade splenic injury. The extensive hemoperitoneum, suggestion of active bleeding, and deterioration in patient aided decision making to proceed with urgent splenectomy (within 1 h from scan time).
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