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.