Presentation
MVA at 100 km/h.
Patient Data
Subcutaneous bruising and hematoma in the right sided anterior abdominal wall and overlying the right iliac crest (seatbelt sign).
Moderate volume hemoperitoneum is present within the pelvis and in the bilateral paracolic gutters, more significant on the right.
Evidence of active hemorrhage in the right iliac fossa. The source of bleeding is difficult to confirm on this mixed phase study.
There is mild mural thickening of the terminal ileum suspicious of traumatic bowel injury. No free gas to suggest perforation. Remainder of the small and large bowel loops are unremarkable.
No solid organ injury.
No injury to the abdominal aorta or major aortic branches. Fat stranding surrounding the left common femoral artery, however flow through the vessel is preserved and no surrounding hematoma identified.
No bony pelvic injury.
Case Discussion
Patient underwent exploratory laparotomy which demonstrated mesenteric tear with active bleeding and mild contusion of the terminal ileum. The bleeding was contained and no bowel resection was performed.
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