Stabbing - liver and colon lacerations

Case contributed by Dr Craig Hacking

Presentation

Stabbing RUQ.

Patient Data

Age: 61
Gender: Male

CTA Thoracic Aorta

No traumatic aortic injury or mediastinal haematoma. No pneumothorax or pleural fluid collection.

No sternal fracture. Old right posterolateral ninth, tenth and eleventh rib fractures. Contour irregularity of the right lateral seventh and eighth ribs without acute fracture line, probably also represent old injuries. No acute rib fracture.

Biapical paraseptal and centrilobular emphysema. Multiple small irregular lung cysts with upper lobe predominance. Multiple small pulmonary nodules, many sub-2mm and groundglass, largest in the lingular measuring 9mm with possible focus of developing internal cavitation anteromedially.

CT Abdomen / Pelvis

Skin to peritoneal defect within the right upper anterior abdominal wall. Deep to this entry site, there is a linear laceration through segment 4B of the liver that extends to a depth of approximately 3 cm. No acute contrast extravasation at this site. This laceration is remote from the hepatic veins, porta hepatis and IVC. The liver surface is irregular, in keeping with known history of cirrhosis. Generalised mottled appearance to the liver is also likely related to the cirrhosis. Associated small to moderate volume haemoperitoneum surrounding the liver, spleen and within the pelvis.

Focal laceration in the anterior wall of the proximal to mid transverse colon. Moderate volume free gas.

No other traumatic injury to the upper abdominal solid organ viscera. No splenomegaly. No direct evidence of small bowel injury. IDC within a collapsed bladder.

No pelvic fracture.

CT Thoracic / Lumbar Spine:

Multiplanar images have been obtained.

Fractures through the spinous processes of T4, T5 and T6 appear well corticated. Furthermore, there is no adjacent soft tissue stranding or haematoma. No acute thoracic spine fracture. No lumbar spine fracture.

Conclusion

  1. Stab wound within the right upper quadrant with underlying laceration through segment 4B of the liver. Associated adjacent subcapsular haematoma and haemoperitoneum.
  2. Laceration to the proximal transverse colon with moderate volume pneumoperitoneum.
  3. Old right-sided rib and spinous processes of T4 to T6 fractures. No acute thoracolumbar spine fracture.
  4. Incidental irregular lung cysts and pulmonary nodules, the largest of the nodules in the lingula measuring 9mm. Although the age and presentation would be unusual, Langerhan's cell histiocytosis / smoking related cystic lung disease is a possibility. Other cystic lung diseases are less likely in this case. Clinical evaluation by respiratory unit and follow-up imaging in 3 months suggested.
  5. Cirrhosis. Heterogeneous liver attenuation may be due to this alone, however non-urgent clinical review and screening for HCC with ultrasound in the first instance should be considered.

Case Discussion

The transverse colon lac was repaired. The liver lac was treated conservatively.

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Case information

rID: 35683
Case created: 16th Apr 2015
Last edited: 8th Aug 2016
Tag: trauma
Inclusion in quiz mode: Included

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