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.