A 67-year-old patient, with no personal history of interest, suffered a fall in the street on the 18th of September 2007 at 20 hours, hitting the lumbar area.
She comes to her GP for presenting low back pain, which increases with the flexure-expression of seizures; analgesic treatment and home observation are prescribed.
Two hours later, the patient was referred to the hospital because of frank hematuria and abdominal pain. The patient complained of severe peritoneal irritation, blood pressure 110/70, and decided to transfer skin and mucosa.
On arrival to the emergency department (about 23 hours) the patient has marked abdominal defense, with tensions of 135/85, heart rate of 94 beats per minute and preserved pulses without data of interest.
ECG showed previously unknown atrial fibrillation.
It presents an analytical with 12.8 g/dl of hemoglobin and 69 % of prothrombin time as the most remarkable data.
It was decided to perform an urgent abdominal CAT with contrast, which was reported as horseshoe kidney with rupture at the central and medial left level, with large retroperitoneal hematoma, with active contrast extravasation close to other renal structures.
1.
5 left retroperitoneal trauma together with the clinical situation of the patient is decided exploratory laparotomy in which a large hemoperitoneum is observed that affects the root of mesentery, consequence of multiple rupture
During the intervention, the patient remains stable, requiring transfusion of 2 concentrates.
In the immediate postoperative period, the patient remains hemodynamically stable, with hemoglobin levels around 10 g/dl, mild fever, continues with some abdominal disfunction and scarce peristalsis.
Abdominal CT performed on 23/9/07 showed a collection of approximately 1 cm in size, opting for active surveillance.
