Case contribution: Dr Radhiana Hassan
Clinical:
- A 14 years old girl
- Involved in MVA, back passenger in a car.
- Assessment showed a closed fracture of distal end right fibula
- POP applied and patient was discharged home.
- Presented 2 days later with severe abdominal pain and vomiting.
- Noted to be dehydrated from the vomitting.
- Also noted drop in Hb from 11 gm/dL to 10 gm/dL
CT scan findings:
- A laceration is seen at lower pole of left spleen (red arrows)
- Less than 3 cm and no active bleed is seen
- No blood collection surrounding the spleen
- Minimal fat streakiness at posterior perisplenic area
- Minimal free fluid at pelvic region
- The left broad ligament is thickened (yellow arrow)
- The uterus also shows heterogenous enhancement with fat streakiness at left lateral wall
Intra-operative findings:
- No capsular laceration seen.
- No perisplenic blood pooling.
- Lacerated left broad ligament and bleeding from branch of left ovarian artery.
- Uterus is normal
Diagnosis: Grade II spleen injury and broad ligament injury from blunt abdominal trauma
Discussion:
- Broad ligament injury is rarely reported as a result of blunt abdominal trauma
- It can be dangerous as they may be silent and not cause obvious vaginal bleeding
- Bilateral broad ligament hematomas in the absence of any injury to the uterus has been reported following pelvic fractures sustained in a pregnant woman during a motor vehicle accident.
- Broad ligament hinjury may be treated either conservatively with blood transfusion, fluid resuscitation, and observation or with surgical exploration and evacuation.
