Splenic, small bowel and pelvic trauma

Case contributed by Dr Andrew Dixon

Presentation

Motorbike accident.

Patient Data

Age: 18 years
Gender: Male

Trauma Series

X-ray

External pelvic binder has been placed. Widened pubic symphysis and right sacroiliac joint consistent with subtle open book diastasis. Fracture of the right inferior pubic ramus. Displaced fracture of the right femoral neck. Abnormal displacement of the coccyx to the right relative to the sacral midline indicating sacro-coccygeal fracture-dislocation. 

CT Abdomen & Pelvis

CT

Multiple lacerations of the inferior aspect of the spleen with associated perisplenic hematoma but no active contrast extravasation. The proximal small bowel loops demonstrate wall thickening and hyperenhancement and there is a small volume of mesenteric fluid between bowel loops. Appearance is suspicious for mesenteric / small bowel injury. No free gas identified to indicate definite bowel perforation. 

Pelvic findings are as seen on the x-ray with the addition of a right anterior acetabular column fracture. There is extra-peritoneal pelvic hematoma associated with the pelvic fractures without active contrast extravasation. Large pre-sacral hematoma is related to posterior sacro-coccygeal dislocation.  

Case Discussion

Multi-trauma abdomen and pelvis case with pelvic diastasis, pelvic hematoma, femoral neck fracture, sacro-coccygeal dislocation, splenic laceration and mesenteric / small bowel injury

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