Traumatic abdominal injuries

Case contributed by Dr James Sheldon

Presentation

Pedestrian hit by motor vehicle

Patient Data

Age: 30 years
Gender: Female
CT

Abdomen/Pelvis

There is a large right perinephric hematoma +/- 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 hematoma 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 ischemic - 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 celiac trunk, consistent with further arterial injury. The vessel immediately distal to this is of small caliber, suggesting associated dissected segment.

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

The lung bases demonstrate large hemothoraces.

Flattened IVC is consistent with volume depletion.

Case Discussion

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

  • massive right renal hilar injury with subsequent embolization
  • mid-left renal artery injury
  • punctate bleeding along internal iliac branches (i.e. active pelvic bleeding)
  • active hepatic bleeding
  • confirmed celiac 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
Published: 31st Dec 2013
Last edited: 6th Sep 2020
Inclusion in quiz mode: Included

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