Small bowel contusion

Case contributed by Dr Bruno Di Muzio

Presentation

MVA at 100lm/h.

Patient Data

Age: 50 years
Gender: Female
CT

CT Abdomen and Pelvis (selected images)

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.

Case Discussion

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. 

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Case information

rID: 59673
Published: 21st Apr 2018
Last edited: 9th Apr 2019
Inclusion in quiz mode: Included

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