Case contribution: Dr Radhiana Hassan
Clinical:
- A 33 years old man
- Alleged MVA, car versus lorry
- Complaint of abdominal pain
- Clinically guarded abdomen, not distended
- BP=100/60mmHg, PR=110 bpm, Hb=11.6 gm/dL
- Bedside ultrasound shows fluid surrounding the spleen
CT scan findings:
- There is intraparenchymal laceration in Segment VII of liver (yellow arrows) about 4 cm in length. No extension to liver capsule. This is consistent with Grade II liver injury.
- Multiple intraparenchymal hematomas in spleen (red arrows), the largest one measures about 3×2 cm. There is associated minimal perisplenic collection. Superficial lacerations are also seen. This is consistent with Grade II spleen injury.
- Fracture of transverse process of right L2/L3 (white arrows)
- Presence of right hydropneumothorax (blue arrows)
- Subcutaneous emphysema bilaterally (orange arrows)
Intra-operative findings:
- Ruptured spleen Grade V, bleeding from pedicle
- Liver, no obvious injury
- Pancreas, kidneys and bowels are normal
- No mesenteric hematoma
- Splenectomy done
Diagnosis: Blunt abdominal trauma with liver and spleen injuries.
Discussion:
- Discrepancies between CT injury grading with intra-operative findings is well documented in previous studies. The discrepancy can be as high as 85%.
- CT findings generally underestimates the severity of injury.
- Thus, clinical correlation is still an important in managing patient with blunt abdominal trauma in deciding whether operative management is required.
