Case contribution: Dr Radhiana Hassan
Clinical:
- A 19 years old man
- Motorcyclist, skidded motorbike
- Complaint of abdominal pain
- On examination, fully conscious, tachycardia. BP normal.
CT scan findings:
- Multiple liver lacerations involving segment VI, VII and VIII (red arrows)
- Lacerations of right kidney (yellow arrows) that shattered the kidney
- Massive perinephric hematoma
- Moderate hemoperitoneum
- No other injury
Intra-operative findings:
- Shattered right kidney at hilum
- Liver laceration involving Segment VI and VIII.
- Gall bladder intact.
- Gross hemoperitoneum. Blood loss 3L.
- Contusion at duodenum and spleen.
- No bowel perforation.
Diagnosis: Grade V right renal injury and Grade IV liver injury.
Progress of patient:
- Right nephrectomy done.
- Liver packing done.
- Repeat CT scan after one month shows complication of biliary leakage.
- Stent was inserted.
Discussion:
- Grade IV liver injury is defined as parenchymal laceration causing disruption 0f 25-75% of a hepatic lobe or 1-3 Couinaud segment within a single lobe.
- Grade IV liver injury also include ruptured intraparenchymal hematoma with active bleeding.
- Grade V renal injury is laceration that completely shatter the kidney or injury to renal hilum with devascularization of the kidney.
