Presentation
An elderly man fell out of bed onto his left side with a complaint of left side abdominal pain.
Patient Data
Laceration about 5 cm deep and involving the inferolateral aspect of the spleen and into the hilum. Active contrast extravasation indicating ongoing hemorrhage. 4.8 cm deep perisplenic hematoma. Large volume hemoperitoneum in the subphrenic space and pelvis.
Left 9th and 10th rib fractures. Cholecystectomy. No other solid organ injury. Bowels are unremarkable. Bladder partially not seen due to metal artifact from hip replacements.
Case Discussion
This elderly male had a fall from less than 1 meter in height, which does not suggest major trauma by definition. However, on presentation to the emergency department, he complained of left abdominal pain and had progressive distension. FAST scan was positive. He was haemodynamically stable and transferred for trauma CT.
His CT brain was negative for intracranial pathology. His CT chest revealed non-displaced left ribs 9 and 10 fractures, although no intrathoracic pathology.
His CT abdomen revealed the splenic laceration with ongoing bleeding. The CT appearances suggest at least AAST grade 4 splenic injury due to the evidence of ongoing active bleeding within the splenic capsule 1. Note that active bleeding is defined as a focal or diffuse collection of contrast which increases in size/attenuation on the delayed portal phase imaging.
The patient was transferred to interventional radiology where the bleeding vessel was successfully embolized.
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