Small bowel contusion
MVA at 100lm/h.
CT Abdomen and Pelvis (selected images)
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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 proximal femoral artery, however flow through the vessel is preserved and no surrounding hematoma identified.
No bony pelvic injury.
Patient underwent exploratory laparotomy which has demonstrated mesenteric tear with active bleeding and terminal ileum mild contusion. The bleeding was contained and no bowel resection was performed.