Case contribution: Dr Radhiana Hassan
Clinical:
- a 23 years old man
- Front passenger of a lorry, skidded and trapped in it
- Vital signs are stable
CT scan findings:
- A few lacerations within the spleen (red arrow). No extension to capsular region. No perisplenic blood collection
- Fat streakiness surrounding left kidney. No parenchymal laceration. No contrast extravasation. Normal enhancement of both kidneys are seen.
- Wall thickening involving small bowels (yellow arrows). No obvious discontinuity seen. No free air.
- Wall thickening also seen involving the descending colon with focal blood pooling posterior to it (white arrows)
Intra-operative findings
- showed small bowel perforation about 4 cm , 90 cm from DJ.
- Serosal tear at descending colon with minimal contamination.
- Minimal hemoperitoneum
- The liver, spleen and kidneys are normal
Diagnosis: Blunt abdominal trauma with bowel, renal and splenic injuries.
Discussion:
- Signs of bowel perforation such as free air and contrast material are virtually pathognomonic.
- Bowel-wall thickening, free fluid, and mesenteric infiltration are other findings suggestive of bowel injury.
Progress of patient:
- Patient also had Left AKA for crush injury of left LL
- Recovered well
