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Basic data:
*
45
Admission date: 2007/09/12
Chief complaint:
diffuse abdominal pain after traffic accident
Present illness:
PE:
Lab Data:
Abdominal CT:
Treatment:
Sep. 13th, 2:35AM hepatorrhaphy + repair of
portal vein and hepatic vein
liver laceration of S4~S7
Sep. 13th, 9:50AM Partial segmentectomy
(S4~S6)
Discussion
Shock, hypotension
Abdominal distension
Anterior abdominal wall bruising
Abdominal pain
Peritoneal signs
Shoulder tip pain (subdiaphragmatic hematoma causing phrenic
nerve irritation)
Penetrating low thoracic wound
Posterior penetrating wound below scapula
Abdominal sonography: intraperitoneal fluid
Diagnostic peritoneal lavage (DPL): blood
CT: blood, collapsed cava, shock nephrogram, small hypodense
spleen (gold stander)
Image Grading
Treatment
Hemodynamically
stable:
IVF challenge
Blood transfusion
Angiographic embolization
Monitor Hct and vital signs
Hemodynamically
unstable:
Operation:
Prognosis
Operative management:
References