Methods
Initial investigations revealed hyperglycaemia, severe leucocytosis and increased PT/INR(Prothrombin Time/International Normalized Ratio). Serial haemoglobin monitoring revealed a fall from initial value of 11.8 gm/dL to 8.6 gm/dL over four hours. Chest X-ray showed a fracture in the right 11th rib. Likewise, a CECT(Contrast Enhanced Computed Tomography) of abdomen and pelvis as shown in figure 2 revealed a large mesenteric hematoma with active extravasation, abutting bowel loops, duodenum and right kidney, and compressing renal vein and inferior vena-cava with mild hemoperitoneum, with no features of solid or hollow viscous injury.
An emergency exploratory laparotomy was performed and intra-operative findings of massive bilateral (right>left) zone II retroperitoneal hematoma as shown in figure in 1, with active arterial bleeding from one of the branches of superior mesenteric artery supplying the ascending colon, was noted which was then ligated, alongside a much smaller hemoperitoneum counterpart. There was no solid or hollow viscous injury. A 24 French(Fr) intra-abdominal drain was placed in hepatorenal pouch of Morrison.