Case History/Examination
A 12 years old boy presented to the emergency department with right
upper quadrant pain, seven hours after sustaining blunt trauma due to
bicycle handle-bar to the right side of his abdomen, which was
continuous in nature and associated with two episodes of non-projectile
vomiting. The vomitus was non-bile stained with presence of undigested
food particles. There was no history of head injury or loss of
consciousness. On primary survey, he was able to articulate well and had
no signs of respiratory distress. But, he had features of shock with
blood pressure of 90/50 mmHg and heart rate of 135 beats per minute. The
rest of the vitals were within normal range. He had a Glassgow Coma
Score(GCS) of 15 with bilateral equal pupils, reactive to light and
there wasn’t any active external bleeding. Extended Focused Assessment
with Sonography for Trauma (eFAST) scan yielded positive in hepatorenal
pouch of Morrison.
He was resuscitated with intravenous fluid, and transfusion with two
units each of packed RBC, FFP(Fresh Frozen Plasma) and platelet
concentrate was begun. Bedside abdominal ultrasound showed around 200mL
collection in the hepatorenal pouch of Morrison, likely hemoperitoneum,
with no gross injury to any solid viscera. After that, a secondary
survey was done which was insignificant. However, on physical
examination, there was presence of rigidity and tenderness over the
right hypochondriac region with sluggish bowel sounds. Apart from this,
no abnormal findings were noted.