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 denies hitting her head or losing consciousness but has had abdominal pain and nausea since the accident. The patient's 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. This patient most likely experienced which of the following injuries?

Question

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 denies hitting her head or losing consciousness but has had abdominal pain and nausea since the accident.  The patient's 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.  This patient most likely experienced which of the following injuries?

Quizplus · Accepted Answer

11ec160b_358b_d2de_9249_2911ad6e99bd_MD0001_00 Retroperitoneal hematomas are commonly associated with abdominal and pelvic trauma. Pancreatic injury is a frequent cause of retroperitoneal hematomas. It can occur following severe blunt or penetrating abdominal trauma, such as from malpositioned seat belts or steering wheels during motor vehicle collisions. 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 frequently performed in patients with blunt abdominal trauma to rule out retroperitoneal hematoma. (Choices B, C, E, and F) 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. (Choice D) Although the abdominal aorta is a retroperitoneal structure, rupture would most likely result in massive and rapid blood loss leading to hemorrhagic shock. Educational objective: Retroperitoneal hematoma is a common complication of abdominal and pelvic trauma. The pancreas is a retroperitoneal organ, and pancreatic injury is frequently a source of retroperitoneal bleeding. __________ References: The diagnosis and treatment of traumatic retroperitoneal hematoma. (http://www.ncbi.nlm.nih.gov/pubmed/24353579)

A 39-Year-Old Woman Is Brought to the Emergency Department After