In a RTA patient sustained trauma to left side of chest and abdomen. Fluid in the peritoneum & sign of hypotension was found on physical examination. Most probable diagnosis is?
ANSWER: (A) Splenic injuryREF: Sabiston 18th ed chapter 20 , Schwartz 9th ed chapter 7Option (A); Splenic injuryThe spleen is the intra-abdominal organ most frequently injured in blunt trauma.Blunt or penetrating trauma mostly of left sideHemoperitoneum causes peritoneal irritation (tenderness, guarding, rebound)Complaints of left upper quadrant pain or of pain referred to the left shoulder (Kehr sign) are highly correlated with injury. At least one fourth of patients with left lower rib fractures have associated injury to the spleen.Hypotension & tachycardia should alert the clinician to the potential for splenic injuryInjury to the spleen is the most common indication for laparotomy after blunt mechanisms of injuryOption (B); Diaphragmatic injuryDiaphragmatic injuries are often caused by venetrating injuries.After blunt trauma, injury to the diaphragm involves both sides equally, as reported in autopsy and CT scan studies, although in clinical practice, left-sided injuries are more frequent.Respirators distress develops when an upright chest film demonstrates visceral herniationOption (C); Rib fractureRib fractures are the most common injuries after blunt chest traumaRibs 4 through 10 are usually fracturedFor each rib fracture there is approximately 100 to 200 mL of blood loss"P Pain on inspiration is usually the primary clinical manifestation after rib fractures. Other clinical signs associated with rib fractures include tenderness to palpation and crepitus.Poor pain control significantly contributes to complications such as atelectasis and pneumoniaOption (D); Renal injuryThe kidney is the most commonly injured part of the urinary tract in blunt trauma typically due to motor vehicle crashes, falls, or assaultsThe pediatric kidney is more susceptible to blunt injury due to the relative lack of perirenal fat and decreased protection from incompletely ossified ribsMost renal injuries are low grade (managed conservatively)Right renal injury is mostly combined with trauma to the fiver, right ribs, and vertebrae while left renal injury is mostly found in combination with splenic trauma or vrith left rib or lumbar vertebrae fracture.Bleeding can be into the retroperitoneal spaces and/or into the collecting system.Gross haematuria is a very important indicator for urinary tract traumaOther clinical findings include back, flank or abdominal pain and shock.
Splenic injury
Diaphragmatic injury
Rib fracture
Renal injury
Abdominal Injury