Shock is one of the leading cause of mortality in blunt trauma. It is also the most reversible condition if diagnosed and manage early. Bariatric trauma is fast becoming common and impose a great clinical dilemma and challenge in emergency medicine. The traditional approach in managing trauma might not be appropriate for this group of patients.
We report 2 case series of bariatric trauma whom presented with blunt injury and refractory hypotension. Both were approached according to advance trauma life support guideline. Hypotension secondary to hypovolemia were identified after ruling out other causes of hypotension. In both cases the challenge was to identify the source of ongoing blood loss as both remain hypotensive despite initial massive transfusion of blood product. There was no evidence of external, abdominal or intrathoracic bleeding detected through clinical examination and repeated point of care ultrasound.
Both case had CT thorax, abdomen and pelvic done. In the first case, there were collection at the lateral part of right hip extending to the right lower abdomen, while in the second case the collection was in the left hip region extending to bilateral lower abdomen.
It was concluded the source of bleeding was from muscle injury involving transversus abdominis and internal and external oblique muscles. The diagnosis of Morel-Lavelle lesion was made based on this. Fortunately, both patient responded well after few hours of aggressive resuscitation in the emergency department.
2 lessons were learnt while managing these cases. Firstly, in bariatric trauma, one must remember the different impact of injury and complication compared to normal patient. The large body surface and many other factors may alter the commonly understood mechanics of injury. Secondly, Morel Lavelle lesion can potentially cause hypovolemic shock in bariatric trauma. One should not miss to look for this potentially life-threatening condition in bariatric patient.
Bariatric, Trauma, hypovolemic shock, Morel-Lavelle