Traumatic mesenteric hematoma and subcutaneous active bleeding

Case contributed by Faeze Salahshour

Presentation

Road traffic accident while riding a motorcycle.

Patient Data

Age: 20 years
Gender: Male

Comminuted displaced fracture of the anterior aspect of the left iliac wing, as well as hematoma with active bleeding in overlying soft tissue. Mild free fluid and a faint laceration in the medial aspect of the spleen. Small hematoma in the proximal jejunal mesentery. No extraluminal free air bubble detected. No oral contrast was administered to explore contrast extravasation.

The red arrow points to faint splenic laceration. The blue arrow shows mesenteric hematoma, and the yellow arrows depict active bleeding in the portal and delayed phases.

The mesenteric hematoma is depicted in the first two photos. Three foci of jejunal wall laceration are seen on two last photos. 

Case Discussion

The patient underwent ulcer washing and dressing, and the active bleeding stopped spontaneously. While conservative management was scheduled, because of patient agitation, an exploratory laparotomy was carried out. GI contents in the peritoneal cavity and three foci of jejunal maceration were found during laparotomy.

 

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