Splenic Injury After Blunt Abdominal Trauma: An Unusual Presentation

Background: The spleen is the most commonly injured viscus in blunt abdominal trauma. Abdominal pain with left upper quadrant tenderness or signs of peritonitis in a patient with history of trauma is the most common presentation of this condition. Objective: To describe an unusual presentation of splenic rupture in a patient with history of motor vehicle crash and blunt abdominal trauma. Case Report: A young man was brought to the Emergency Department with a history of being in a motor vehicle crash 10 h earlier. He experienced gradually worsening difficulty breathing while sitting or lying down for the previous 4 h, although he was asymptomatic in the upright position. He was transported to the hospital standing upright, supported by two men, on the open back of a vehicle normally used to transport cattle. The patient was found to have left upper quadrant abdominal tenderness on examination and free fluid in the pelvis on the focused abdominal sonography for trauma examination done while the patient was standing. A grade III splenic injury with hemoperitoneum was diagnosed on computed tomography scan and the patient was treated with splenectomy. Conclusion: We report an unusual presentation of a splenic injury in a young man who had symptoms only in the supine position.     

急诊B超检查在急腹症中的应用价值

目的探讨急诊B超检查在急腹症中的应用价值。方法E505例急腹症患者作急诊B超检查，并将结果与临床最后诊断相对照分析。结果505例受检患者，外伤组202例，检出胸腹腔脏器损伤出血共21例，检出率100％，腹腔脏器损伤定位符合率71．8％，非外伤组303例，检出与急腹症相关疾病共154例，检出率87．5％。结论急诊B超检查在外科与妇产科急腹症中具有较高的检出率与诊断符合率。     

Isolated bladder rupture after minor trauma in a patient with alcohol intoxication

We report the case of an intoxicated male patient who presented with an isolated intraperitoneal urinary bladder rupture, with a history of minor trauma. A review of the literature reveals that isolated bladder rupture after minimal or no trauma in association with alcohol or drug ingestion is an infrequently reported, but recognized, injury. The diagnosis of bladder rupture should be considered in an intoxicated patient with lower abdominal pain, even without a history of trauma. A history of voiding or bladder dysfunction should increase the suspicion for this injury. If suspected, a retrograde cystogram should be obtained promptly. Failure to consider and recognize this injury may lead to significant morbidity.     

Massive left diaphragmatic separation and rupture due to coughing during an asthma exacerbation

We report a case of herniation of abdominal contents into the left hemithorax in a patient hospitalized with an acute exacerbation of asthma accompanied by paroxysms of coughing. There was no history of trauma. We believe this is the first reported case of diaphragmatic rupture complicating an asthma exacerbation. We review clinical features, pathophysiology, diagnosis, and treatment of diaphragmatic rupture in its most common setting, trauma, and discuss its occasional "spontaneous" occurrence.     

Blunt abdominal trauma.

Blunt abdominal trauma is a possible sequel of many accidents and can result in death from hemorrhage or sepsis if it is not detected early and managed aggressively. A thorough history of the causative accident, a systematic abdominal examination, selected laboratory studies, and x-ray films are helpful in establishing the diagnosis. Peritoneal lavage is, however, the most reliable assessment tool (besides an exploratory laparotomy) for confirming significant viscus injury and intra-abdominal hemorrhage. Nurses who are assisting in the evaluation of trauma victims should be thoroughly familiar with the mechanics responsible for blunt abdominal injury, the initial steps for stabilizing the victim, and the usual tests and procedures that aid in diagnosis.     

Natural history of inferior mesenteric arteriovenous malformation that led to ischemic colitis: A case report

BACKGROUNDIschemic colitis with inferior mesenteric arteriovenous malformation (AVM) is a rare disease. Although a few reports have been published, no report has described the natural history of idiopathic mesenteric AVM. CASE SUMMARYA 50-year-old male was admitted to our hospital due to abdominal pain that had persisted for 3 mo and bloody diarrhea. He had no history of trauma or abdominal surgery. He had undergone two colonoscopies 6 mo and 2 years ago, and they showed only a polyp. He was diagnosed with ischemic colitis with inferior mesenteric AVM following contrast-enhanced abdominal computed tomography (CT) and underwent rectal low anterior resection. He has not had a recurrence of symptoms for 3 years. His history showed that he had undergone non-enhanced abdominal CT 2, 5, and 8 years ago when he had attacks of urinary stones. Retrospectively, dilation of blood vessels around the rectosigmoid colon could have been detected 5 years ago, and these findings gradually became more evident. CONCLUSIONThis is the first report of the natural history of inferior mesenteric AVM.     

Ultrasonography in the management of liver trauma in children.

Three cases of blunt abdominal trauma with conservative management are presented. All cases were followed with ultrasonography. In two cases the lesions showed significant increases in their cystic components before reduction in size and complete resolution. The natural history of damaged liver tissue is discussed. Conservative management with ultrasonographic follow-up of selected cases of liver trauma in children is advocated.     

An unusual pelvic mass: Contrast-enhanced sonographic diagnosis of pelvic splenosis

Splenosis is an unusual condition representing auto-transplantation of splenic tissue following splenic trauma or surgery. When detected on imaging studies, the splenosis deposits are usually misinterpreted as pathological masses. We present a case where a pelvic mass incidentally visualized on an MRI examination, was proven to represent a deposit of splenosis by contrast enhanced ultrasound (CEUS). CEUS demonstrated persistent late-phase enhancement characteristic of splenic tissue. Ultrasound practitioners should be aware of this condition when an unusual abdominal or pelvic mass is encountered in a patient with a history of splenic trauma or surgery. CEUS is ideally suited to confirming the diagnosis.     

Duodenal Hematoma

A black eye, multiple scratches and bruises, and frequent vomiting were the clues that led to the x-ray diagnosis of duodenal hematoma in a little girl complaining of abdominal pain. A history of abdominal injury could not be obtained, but significant trauma must have occurred.     

A rare case of infected splenic hematoma

Splenic hematoma is a relatively benign condition in consideration that a majority are spontaneously absorbed. Rarely, they can become infected, a condition that is difficult to diagnose and is associated with significant morbidity and mortality if left untreated. We present a patient with a known history of intravenous drug abuse and recent abdominal trauma who was found to have infective endocarditis and subsequently an infected splenic hematoma. The related literature is also discussed.     

Abdominal pain in a child after blunt abdominal trauma: an unusual injury

We report a case of perforation of a walled off appendiceal abscess in a 5-year-old boy who sustained blunt abdominal trauma. The past medical history was significant only for a 4-day episode of abdominal pain 1 month prior to this presentation. Initial laboratory studies were unremarkable, and radiographic studies showed free fluid in the pelvis with no evidence of solid organ injury, but inflammation of the right colon. The final diagnosis was made at laparotomy. We emphasize this unique presentation and review the literature on traumatic appendicitis in children.     

‘Pseudopneumothorax’—Hold that chest tube!

We report a case of herniation of abdominal contents into the left hemithorax in a patient with a history of vague left-sided thoracoabdominal trauma 18 days previous to admission and who also had a recent 1-week history of upper respiratory symptoms, including cough, and then presented with dyspnoea and fever for 3 days. There was no preceding cardiorespiratory pathology of note. We also discuss the epidemiology, pathogenesis and management of blunt-traumatic diaphragmatic rupture.     

Ultrasound-guided percutaneous drainage of a traumatic abdominal wall hematoma in the emergency department

BACKGROUND:

Abdominal wall hematoma is due to trauma, coagulation disorders or anticoagulation therapy complications.

METHODS:

In this report we present a case of a 44-year-old female who suffered from blunt abdominal trauma and presented to the emergency department with sharp abdominal pain and ecchymosis. FAST and abdominal computerized tomography (CT) revealed an abdominal wall hematoma. Treatment with an ultrasound-guided percutaneous drainage was performed successfully.

RESULTS:

The patient remained under observation for six hours with serial ultrasound scans, and no signs of hematoma recurrence were present. She was discharged the same day with clinical improvement.

CONCLUSION:

Complete history investigation and clinical examination help to make a correct diagnosis of abdominal wall hematoma, select a prompt treatment, and reduce complications.KEY WORDS: Rectus sheath hematoma, Abdominal wall hematoma, Emergency Department, FAST, Ultrasound guided percutaneous drainage     

Traumatic, pericardio-diaphragmatic rupture: an extremely rare cause of pericarditis

A 54-year-old man with a recent history of blunt abdominal trauma presented to the Emergency Department with severe pain in the chest and abdomen. He was tachycardic, tacypneic, and hypoxic. An electrocardiogram (EKG) at that time showed ST elevation and PR depression consistent with acute pericarditis, and a computed tomography (CT) scan subsequently showed herniation of abdominal contents into the pericardium and left hemithorax. After surgical repair of the diaphragmatic defect and intrapericardial hernia, the EKG findings resolved. He recovered over the course of several weeks and was subsequently discharged home.     

Thoracic disk herniation presenting as abdominal and pelvic pain: a case report

We report the case of a young woman who presented with a 2-month history of severe abdominal and pelvic pain. The past history was significant for a fall from a bicycle 1 week before the onset of her pain. Physical examination was remarkable for periumbilical tenderness. Work-up including pelvic sonogram and diagnostic laparoscopy suggested endomyometritis. The pain was minimally relieved by nonsteroidal anti-inflammatory drugs and narcotic analgesics. Thoracic spine magnetic resonance imaging (MRI) revealed a large disk herniation at the T9-10 level compressing the spinal cord. The patient subsequently underwent T9-10 diskectomy and laminectomy with dramatic relief of her symptoms. Postoperative rehabilitation hastened her functional improvement. This is a rare case of symptomatic thoracic disk herniation after trauma presenting as abdominal and pelvic pain. Physicians should be aware of this unusual presentation of thoracic disk herniation to avoid invasive diagnostic procedures.     

超声造影在腹部外伤急诊诊断中的应用

目的:探讨超声造影技术在腹部急诊外伤超声诊断中的应用价值。方法:对61例腹部急诊外伤患者进行二维超声及超声造影检查,对损伤程度进行分级。检查结果与手术、血管造影等对照,分析不同超声技术在腹部闭合性损伤中的诊断价值。结果:超声造影能安全的用于闭合性腹部损伤患者损伤的诊断,对于判断腹部实质性脏器,如肝、脾、肾等损伤较常规超声技术有较高的灵敏度,并进行损伤程度分级,结果得到血管造影及手术证实。结论:超声造影技术在腹部外伤急诊诊断中有很高的应用价值,值得临床推广。     

Tension Viscerothorax after Blunt Abdominal Trauma: A Case Report and Review of the Literature

Background

Tension viscerothorax is herniation of abdominal viscera into the thorax. Tension viscerothorax can simulate tension pneumothorax. Immediate decompression with a nasogastric tube is required for hemodynamic stabilization.

Objective

A case of tension viscerothorax is reported along with a review of the literature to highlight this rare complication of blunt abdominal trauma, and to emphasize the importance of nasogastric tube decompression in tension viscerothorax.

Case Report

A 10-year-old boy with a remote history of trauma related to a motor vehicle crash was brought into the Emergency Department with a 3-day history of vomiting, epigastric pain, and dyspnea. By physical examination and chest X-ray study, tension gastrothorax was diagnosed. Nasogastric tube placement was difficult and delayed, and the patient deteriorated into cardiac arrest, but after successful cardiopulmonary resuscitation and nasogastric tube insertion, the patient was stabilized. Laparotomy was performed and primary repair of a ruptured diaphragm was done. The patient made an uneventful recovery.

Conclusion

Acute tension viscerothorax should be considered in the differential diagnosis of tension pneumothorax, and its initial resuscitation should include nasogastric tube insertion for immediate decompression.     

腹部脏器损伤的超声诊断

目的探讨超声检查在腹部外伤中的应用价值。方法回顾分析在本院住院治疗的244例腹部脏器损伤病人的声像图表现。结果肝损伤93例，B超所见符合率为100％；脾损伤99例，符合率为100％；肠系膜血肿12例，符合率为60％；胃肠道损伤40例，符合率为100％。所有腹部外伤病人均有腹腔积液发生，符合率为100％。结论超声检查能正确及时地做出腹部脏器损伤的诊断，对损伤的程度可根据腹腔积液的多少作出大致的判断，为临床决定是否手术提供重要信息。超声检查可作为腹部外伤病人常规必检项目。     

Spontaneous occlusion of splenic and renal pseudoaneurysm after blunt abdominal trauma: a case report and literature review

Pseudoaneurysms caused by blunt abdominal trauma are rarely observed in solid organs. The preferred therapy for pseudoaneurysm after blunt abdominal trauma is often angiography and embolization. Here, we report a case of a spontaneous occlusion of splenic pseudoaneurysm and renal pseudoaneurysm after blunt abdominal trauma. Angiography and embolization were not required, and contrast-enhanced multi-detector computed tomography was used to monitor the patient. This case shows that spontaneous occlusion can be one of the possible outcomes of intraparenchymal splenic pseudoaneurysm and renal pseudoaneurysm after blunt abdominal trauma.