A 39-year-old woman is brought to the emergency department after an end-to-end motor vehicle collision. She was a restrained passenger and did not hit her head or lose consciousness. She has had abdominal pain and nausea since the collision. Blood pressure is 115/55 mm Hg and pulse is 96/min and regular. On examination, she has ecchymosis over the area of the seat belt and abdominal tenderness. CT scan of the abdomen reveals a retroperitoneal hematoma. Which of the following injuries is most likely to be responsible for this patient's internal bleeding?
Show Explanatory Sources
Retroperitoneal hematomas are commonly associated with blunt abdominal trauma and typically reflect injury to one of the retroperitoneal organs. Pancreatic injury is a frequent cause, and may result from blunt abdominal trauma that rapidly compresses the pancreas against the vertebral column, as may occur from a high-riding seat belt or a steering wheel during a motor vehicle collision.
Pancreatic injury with retroperitoneal hematoma may initially cause only mild symptoms or be asymptomatic, but it can lead to life-threatening blood loss. Therefore, an abdominal CT scan is usually performed in patients with blunt abdominal trauma to rule out retroperitoneal hematoma as well as other intraabdominal injuries.
(Choices B, C, D, and E) The spleen, liver, stomach, and transverse colon are intraperitoneal organs. Lacerations or rupture of these organs can occur in blunt abdominal trauma, but these injuries would lead to hemoperitoneum (free blood in the peritoneal space), not retroperitoneal hematoma.
Educational objective:
Retroperitoneal hematoma is a common complication of blunt abdominal trauma. The pancreas is a retroperitoneal organ, and pancreatic injury is frequently a source of retroperitoneal bleeding.