PMC7533056_01
Large ecchymosis on the left trunk and hip. Skin discolorations are still present 10 days after the trauma.
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Multiple abrasions, friction burns, bruises, contusions, and haematomas over the abdomen were also found, mainly on the left side at the paraumbilical and left loin areas (Fig. 1).
CT chest shows signs of bilateral COVID-19 pneumonia.
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These features are suggestive of COVID-19 related pneumonia (Fig. 2).
CECT coronal view. Black arrow showing the RSH dissected down to the pelvis, blue arrow showing inguinal extension, yellow arrow showing left abdominal wall haematoma and the red arrow showing mild perihepatic free fluid.
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CECT again to have a preoperative assessment, to localize the constant bleeding source if possible, and to rule out active bleeding from the spleen. CECT found a marked increase in the size of the lower dissecting part of a previously diagnosed left-sided huge RSH, to become filling most of the left pelvis (Fig. 3), causing compressing and deviating toward the right side of UB.
All 3 components of the haematoma: yellow arrow showing the RSH, blue arrow showing the pelvic extension and the black arrow showing the retroperitoneal part surrounding the left ureter.
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A similar appearance of minimal extraperitoneal free fluid at the psoas muscle (Fig. 4), with newly appeared minimal amount fluid at descending colon and left perinephric space (left retroperitoneal), was also seen.
1-RSH, 2. Left abdominal wall haematoma, 3- mild dilated right ureter 7.5 mm, 4- dilated left ureter 10.5 mm.
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Both kidneys reveal normal nephrogram and excretory phases, and outlining of the ureters are mildly dilated (Fig. 5), seen 60 s after injection of contrast media, about 7.5 mm on the right side and 10.5 mm on the left side- most likely related to right side deviation of UB and compression by large pelvic haematoma (Fig. 6).
Yellow arrow showing the left RSH extended down to the pelvis and the black arrow showing the displaced UB towards the right side.
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Both kidneys reveal normal nephrogram and excretory phases, and outlining of the ureters are mildly dilated (Fig. 5), seen 60 s after injection of contrast media, about 7.5 mm on the right side and 10.5 mm on the left side- most likely related to right side deviation of UB and compression by large pelvic haematoma (Fig. 6).
Post Laparotomy wound healed by primary intention. Ecchymosis at the surgery side (left) resolved faster than right side. 14th post-laparotomy day.
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The laparotomy wound skin clips were removed 12-13 days after the surgery (Fig. 7).