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UNCOMMON ABDOMINAL HEMORRHAGE DUE TO BLUNT TRAUMA: BLENDING FROM AN ASYMPTOMATIC ABDOMINAL TUMOR INJURY – A CASE REPORT
Author(s) -
Collet e Silva F. S.,
Bardella R.,
Fontes B.,
Poggetti R. S.,
Birolini D.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04133_15.x
Subject(s) - medicine , abdomen , surgery , laparotomy , asymptomatic , abdominal trauma , abdominal mass , glasgow coma scale , abdominal cavity , blunt , physical examination , radiology
Asymptomatic tumors are not uncommon, may be diagnosed during clinical examination or during surgical interventions for other purposes such as treatment of a hemorrhage due a blunt trauma. Case report 6 year‐old boy had fallen, hitting his abdomen against a rock, and arrived at hospital ten hours later. Initial assessment he was complaining of diffuse abdominal pain; his physical examination showed: respiratory rate: 16 mov/min, blood pressure: 100 × 80 mmHg, heart rate: 100 bat/min, and Glasgow coma score: 15. His abdomen was distended, with guarding and rebound tenderness, and had a palpable mass. FAST ultrasound was positive; and Ct‐scan showed an abdominal mass with 15 × 12 × 7 cm dimension, and moderate amount of free blood in the abdominal cavity. Laboratory tests showed: hemoglobin 9.9 mg/dl, hematocritic 28.8%, white blood cells 6.900 cel/dl. Midline laparotomy was performed, a large, injured and bleeding mesenteric mass was found encircling superior mesentery artery and several small bowel loops; 500 ml of free blood was found in the peritoneal cavity. Mesenteric mass was partially removed with a segment of the small bowel. Findings of anatomico‐pathologic examination revealed an intestinal Burkitt lymphoma, with mesenteric linfonodes. Patient had an uneventful postoperative course, and started with quimotherapy. Comments This case report shows an unusual traumatic abdominal blending that could not be clearly diagnosed before laparotomy was performed. The emergency of this case was bleeding control, decision to remove mass was taken only for this purpose, and not to treat the tumor. As removal of the whole mass was impossible, a partial removal was performed.