Traumatic abdominal injuries

Case contributed by Dr James Sheldon

Presentation

Pedestrian hit by motor vehicle

Patient Data

Age: 30
Gender: Female
CT

Abdomen/Pelvis

There is a large right perinephric haematoma +/- urinoma with significant contrast extravasation representing active bleeding. This appears largely arterial with a prominent pseudoaneurysm, however a component of renal vein / IVC injury is also suspected given a small discrete blush of contrast closer to this area.

There is a right lobe of liver haematoma measuring at least 4 cm x 4.5 cm with areas of contrast extravasation. Laceration extends to the porta without traversing and there is no discrete extravasation in this region.

The spleen is uniformly hypodense and likely infarcted.

The left kidney demonstrates heterogeneous enhancement with areas of hypoattenuation, likely ischaemic - arterial injury not excluded. Blushes of contrast just posterior and inferior to the left renal vein are suspicious for lumbar venous injury.

The small bowel wall is markedly thickened and shock bowel is suspected. Extensive rectal injury which communicates with open pelvic and sacral fractures. Surgical packing in place.

There is contrast extravasation / pseudoaneurysm at the inferior margin of the origin of the coeliac trunk, consistent with further arterial injury. The vessel immediately distal to this is of small calibre, suggesting associated dissected segment.

The left adrenal gland appears normal. The right adrenal gland is not identified - likely infarcted.

The lung bases demonstrate large haemothoraces.

Flattened IVC is consistent with volume depletion.

Case Discussion

This case demonstrates severe multi-organ trauma. The patient required angio-embolisation:

  • massive right renal hilar injury with subsequent embolisation
  • mid-left renal artery injury
  • punctate bleeding along internal iliac branches (i.e. active pelvic bleeding)
  • active hepatic bleeding
  • confirmed coeliac dissection/pseudoaneurysm 

Other injuries demonstrated:

  • splenic infarct
  • right adrenal gland infarct (likely)
  • shock bowel (suspected)
  • rectal injury
  • open pelvic and sacral fractures
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Case information

rID: 26629
Case created: 31st Dec 2013
Last edited: 6th Dec 2015
Inclusion in quiz mode: Included

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