e-CASES: Abdominal vessels trauma, Intraperitoneal bladder rupture, Spleen infarction, Pelvic fracture
24-year old female patient, light vehicle road traffic accident, at 90 kmph, would appear to have been thrown over a bridge.
In the initial examination, indeterminate abdomen with hypogastric guarding, blood creatinine at 199 micromols/l with no known previous history, stable hemodynamic status.
- No posttraumatic lesions in the cranioencephalic space (left thyroid nodule to be evaluated at a later date) or in the thoracic space (common bilateral gravity-dependant ventilation disorders). No posttraumatic lesions of the cervico-thoraco-abdomino-pelvic spine.
- Trauma to the proximal portion of the celiac trunk with non-obstructive intraluminal thrombi (due to probable laceration of the intima) and splenic ischemia (probable emboli).
- Very abundant intraperitoneal fluid effusion following large intraperitoneal rupture of the vesical dome.
- Subcutaneous emphysema of the left anterior abdominal wall with inguinal skin wound.
- Stable multi-fragment fracture of the left iliac wing, with no damage to the acetabulum. Avulsion fracture of the left anterosuperior iliac spin (with probable disinsertion of the sartorius).
- No other traumatic lesions of the intra-abdominal solid organs (liver steatosis).
Abdominal vessels trauma, Intraperitoneal bladder rupture, Spleen infarction, Pelvic fracture
- Emergency urological care with celioscopic suture of the intraperitoneal bladder rupture. The intraperitoneal investigation confirmed the presence of a large, transverse bladder rupture at the dome, measuring approximately 8 cm in length. No other posttraumatic lesions in the abdominal cavity.
- Conservative treatment of the pelvic fractures.
- Anticoagulant and anti-platelet medication for at least 1 month followed by consultation with a vascular surgeon for the celiac trunk injury (the follow-up CT scan at 4 days revealed resolution of the thrombi in the celiac trunk).
- Systematically examine the permeability of the abdominal arterial structures.
- In the event of abundant intraperitoneal fluid effusion with no traumatic lesions of the intra-abdominal solid organs, perform a late phase scan to detect bladder rupture.
- Unlike contusion, ischemia of a solid organ is not enhanced.