We report two cases of uncommon vascular lesions (Littoral cell angioma and liver haemangioma) mimicking traumatic organ injuries. The patients' histories and clinical findings of trauma were well demonstrated. Both patients had interesting CT scan features that were suggestive of solid organ injuries. However, both conditions were subsequently found to be benign incidental lesions.
Pseudohyperkalemia is a spuriously high serum potassium measurement in a patient with no clinical evidence of hyperkalemia. It has been reported to occur in patients with leukocytosis and thrombocytosis. Only a few cases of pseudohyperkalemia have been reported in patients after splenectomy. Two cases of pseudohyperkalemia occurring after emergency splenectomy for abdominal trauma are presented to highlight their clinical presentation and sequalae. Consecutive patients who underwent emergency splenectomy for trauma and subsequently developed pseudohyperkalemia were monitored in Universiti Kebangsaan Malaysia Medical Centre for their clinical sequalae. Both the patients developed leukocytosis, thrombocytosis and high serum potassium level within 2-weeks of their splenectomies. They did not demonstrate any symptoms and signs of hyperkalemia. Their conditions resolved spontaneously without any specific treatment. Pseudohyperkalemia should be suspected in a similar clinical scenario to avoid unnecessary treatment that could lead to severe hypokalemia.
Traumatic abdominal wall hernia (TAWH) after blunt injury is uncommon. Diagnosis requires careful examination and high index of suspicion. We report a case of a 12-year-old boy who complained of painful abdominal swelling over the left iliac fossa after a bicycle-handlebar hit his abdomen. TAWH was diagnosed clinically and confirmed with ultrasound and computed tomography (CT) scan. He developed incarceration after 12 hours of admission and subsequently underwent primary repair without mesh. As TAWH is usually associated with other concomitant injuries, it is important that we are meticulous to rule out other serious concomitant injuries.
Transverse sacral fracture is a very rare injury and frequently missed or delayed in diagnosis. We present a case with this injury and discuss its management.
Multislice computed tomography (MSCT) is the imaging modality of choice in assessing clinically stable patients with blunt abdominal trauma. This study assessed the role of MSCT in the detection of intra abdominal injury caused by blunt trauma in our centre within a two-year-period (2008-2009). A total of 151 patients had MSCT abdomen for blunt abdominal trauma within this study period. Positive scan were seen in 126 patients (83.4%). Out of these positive scans, liver, spleen and renal injuries were seen in 42.1% (n = 53), 34.9% (n = 44) and 30.0% (n = 34) of cases respectively. Laparotomies were performed in 45 patients. Out of these 45 laparotomies, 10 patients had surgically significant injuries that were missed on CT scan findings. The injuries were bowel perforation (n = 4), serosal tear of bowel (n = 1), mesenteric injuries with active haemorrhage (n=3), spleen injury (n = 1) and liver injury (n = 1).
An acute abdomen in pregnancy can be caused by pregnancy itself, be predisposed to by pregnancy or be the result of a purely incidental cause. These various conditions are discussed. The obstetrician often has a difficult task in diagnosing and managing the acute abdomen in pregnancy. The clinical evaluation is generally confounded by the various anatomical and physiological changes occurring in pregnancy itself. Clinical examination is further hampered by the gravid uterus. The general reluctance to use conventional X-rays because of the pregnancy should be set aside when faced with the seriously ill mother. A reluctance to operate during pregnancy adds unnecessary delay, which increases morbidity for both mother and fetus. Such mistakes should be avoided as prompt diagnosis and appropriate therapy are crucial. A general approach to acute abdominal conditions in pregnancy is to manage these problems regardless of the pregnancy.
Introduction: Splenic pseudo-aneurysm is an uncommon complication following splenic injury caused by blunt abdominal trauma. Pseudo-aneurysm is usually treated with splenic arterial embolisation. Spontaneous thrombosis of a splenic pseudo-aneurysm can occur but it is rare. Method: We report a case of spontaneous thrombosis in a post-traumatic splenic pseudo-aneurysm. The patient was managed conservatively as he was haemodynamically stable with a repeat CT scan on the 7th day showing a tubular enhancing structure in the upper pole of the spleen demonstrating the same attenuation value .
Conclusion: This case illustrates a spontaneous resolution of splenic pseudo-aneurysm, which is a rare outcome of the condition.
Postmortem radiographic examinations of animals are commonly performed in judicial investigations to rule out gunshot and fractures. However, there was no available data on radiographic postmortem changes of animals. Forty-one sets of abdominal radiographs of feline cadavers made within 12 h of death were evaluated for postmortem changes. Intravascular gas was detected in 11 of 41 (27%) cadavers. The most common site of intravascular gas was the liver. Intravascular gas was also present in the aorta, femoral artery, celiac and cranial mesenteric arteries, and caudal superficial epigastric artery. Intrasplenic gas was detected in two cadavers. Only two cadavers had distended small intestine. One cadaver had pneumatosis coli. The changes detected were most likely due to putrefaction.
The resurging interest in diagnostic laparoscopy has witnessed its increasing application in trauma surgery. Such unbridled enthusiasm has at times overlooked its shortcoming in the diagnosis and management of certain in abdominal injuries. We report and discuss one such conspicuous limitation and advocate that the use laparoscopy in abdominal trauma should be tempered with caution.
Pancreatic injury in paediatrics is a rare condition and can be difficult to diagnose. The diagnostic challenge is due to its symptom of vague abdominal pain which usually results in late presentation. Elevated biochemical markers such as amylase and lipase can aid in the evaluation of pancreatic injury, however, it is not specific and is only evident after several hours of trauma. Ultrasound is commonly used as a primary modality to evaluate abdominal organ injuries, but its role in detecting pancreatic injury is limited due to low sensitivity. High index of suspicion is needed to avoid undiagnosed pancreatic injury which could be lethal to children. We herein report a case of delayed presentation of isolated pancreatic tail injury in a child who was sufficiently diagnosed with ultrasound and treated conservatively. Proper initial assessment and diagnosis will allow appropriate management of pancreatic injury. Conservative management should include serial imaging to look at the evolution of pancreatic injury and detect complications such as pseudocyst or abscess formation.
Timely identification of specific injuries in a polytrauma case is of paramount importance in order to reduce morbidity and mortality. Unfortunately, some of these injuries are subtle and can be missed on initial primary and secondary assessments. In this paper, we report one such injury in a case of a 16-year old motorcyclist who complained of abdominal pain over the right lumbar region after the motorcycle handlebar hit his abdomen. Although initial assessment was uneventful, he was subsequently diagnosed to have a traumatic abdominal wall herniation on abdominal computed tomography after more than 24 hours of observation in the ward.
Retroperitoneal duodenal rupture due to blunt abdominal trauma is relatively uncommon. Diagnosis is difficult because the physical signs are subtle or they are difficult to interpret. A case of retroperitoneal duodenal rupture due to blunt abdominal trauma in whom the diagnosis was delayed is reported. Radiographic features are discussed. The role of early roentgen diagnosis is stressed in order to reduce the very high mortality which is associated with delay in diagnosis and treatment.
Details of a young logger who sustained a clean prevertebral transection of the pancreas to the left of the superior mesenteric vessels and a crush injury in segments 2 and 3 of the liver are presented. CT scan was not done but ultrasound scan revealed free intraperitoneal fluid and no comment was made about the pancreas. The pancreatic injury was discovered at laparotomy carried out 24 hours after admission and treated by resection.
Damage Control Resuscitation and Surgery is the concept of controlled hypotension, haemostatic resuscitation and abbreviated surgical procedures following severe trauma; the practice of which has resulted in improved mortality and morbidity. We describe a rare case of thoraco-abdominal impalement successfully managed based on the concept of Damage Control Resuscitation.
The spleen is one of the organs most frequently injured in blunt abdominal trauma. Computed tomography (CT) scanning can accurately detect splenic injury and is currently the imaging modality of choice in assessing clinically stable patients with blunt abdominal trauma. The CT features of spleen injury include lacerations, subcapsular or parenchymal haematomas, active haemorrhage, and vascular injuries. We present a pictorial review of the spectrum of CT findings for blunt splenic injuries. This article will be a useful reference for radiologists and surgeons as CT scan is widely used for the assessment of splenic injuries and contributes to the current trend towards nonsurgical management of this injury.
Renal injury is observed in 10 percent of cases of abdominal trauma, and the majority (80 percent to 90 percent) of these are attributable to blunt trauma. Intravenous urography and ultrasonography of the abdomen were previously the modalities of choice in the imaging of renal injuries. However, computed tomography (CT) is currently the imaging modality of choice in the evaluation of blunt renal injury, since it provides the exact staging of renal injuries. The purpose of this article is to describe the CT staging of renal injuries observed in blunt abdominal trauma based on the Federle Classification and the American Association for the Surgery of Trauma renal injury severity scale.
Computed tomography (CT) is currently the diagnostic modality of choice in the evaluation of clinically stable patients with blunt abdominal trauma, including the assessment of blunt bowel and mesenteric injuries. CT signs of bowel and/or mesenteric injuries are bowel wall defect, free air, oral contrast material extravasation, extravasation of contrast material from mesenteric vessels, mesenteric vascular beading, abrupt termination of mesenteric vessels, focal bowel wall thickening, mesenteric fat stranding, mesenteric haematoma and intraperitoneal or retroperitoneal fluid. This pictorial essay illustrates CT features of bowel and/or mesenteric injuries in patients with blunt abdominal trauma. Pitfalls in interpretation of images are emphasized in proven cases.
Blunt abdominal trauma can cause multiple internal injuries. However, these injuries are often difficult to accurately evaluate, particularly in the presence of more obvious external injuries. Computed tomography (CT) imaging is currently used to assess clinically stable patients with blunt abdominal trauma. CT can provide a rapid and accurate appraisal of the abdominal viscera, retroperitoneum and abdominal wall, as well as a limited assessment of the lower thoracic region and bony pelvis. This paper presents examples of various injuries in trauma patients depicted in abdominal CT images. We hope these images provide a resource for radiologists, surgeons and medical officers, as well as a learning tool for medical students.
Thirty-five patients with blunt hepatic injuries treated in a 7-year period are reviewed. The difficulties of diagnosis are stressed in that only 48.6%c were diagnosed
preoperatively. Associated intra-abdominal and concomitant head, chest, pelvic and skeletal injuries accounted for most of these difficulties. Seventeen of the 35 patients had extensive lacerations or intra-lobar ruptures of the liver. Simple linear or stellate lacerated wounds were treated by drainage, or suture, or debridement of the ragged liver edges and suture. Prior to 1964 extensively lacerated liver wounds were treated by gauze packing. Three (60%c) of five patients thus treated died, while the others had multiple complications. Since 1964, packing has been abandoned in favor of major resection and of 11 patients who underwent such procedures only one died. Hepatic resection for severe blunt injuries has the advantages of removal of all devitalized liver, control of hemorrhage, reduction of postoperative complications such as secondary hemorrhage, intraabdominal and hepatic abscesses and hemobilia. Hepatic resection is recommended for subeapsular hematomas with intra-lobar rupture of the liver to avoid hepatic necrosis. These injuries are diagnosed by injection of methylene blue into the common hepatic duct. Low mortality and morbidity in this series is due to improved care of injured pa-tients, early surgical intervention and adequate removal of devitalized lacerated and injured tissues by debridement or major hepatic resection.