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Zulfaqar Bin Othman Thani Muhamad Akmal Bin Mohammad Cheng Hee Song

Abstract

Introduction: Adrenal gland hemorrhage is an uncommon injury following blunt abdominal trauma. It poses high mortality rate as it is frequently associated with adjacent organ or skeletal injuries.

 

Case report: We report a case of 16-year-old female who presented to our emergency department for blunt trauma following a high-speed motor vehicle collision as a helmeted motorcyclist. On arrival, her Glasgow coma score was 5/15 and required endotracheal intubation for airway protection. Physical examination revealed right periorbital hematoma and bruises over left upper chest. Her abdomen was otherwise soft with no acute peritoneal signs. A focused assessment with sonography for trauma (FAST) examination was performed and found to be negative. A computed tomography (CT) scan of abdomen was subsequently performed owing to the hypotensive episode in emergency room which demonstrated right adrenal haematoma measuring 10.3cm x 7.6cm x 14cm causing compression to adjacent inferior vena cava. The left adrenal gland is otherwise normal and no other solid abdominal organ injury is found. Her condition deteriorated and she eventually succumbed to her injuries 12 hours after trauma.

 

Discussion: Isolated adrenal haemorrhage is rare following blunt abdominal trauma due to its deep retroperitoneal position with cushioning effect by surrounding tissues. Abdominal CT scan is the most useful diagnostic modality compared to ultrasound in assessing retroperitoneal structures. Isolated adrenal gland haemorrhage is usually treated conservatively but cases of active adrenal haemorrhage requiring transarterial embolization have been reported. Prompt corticosteroid treatment can be life saving in adrenal insufficiency secondary to bilateral adrenal glands haemorrhage.

 

Conclusion: Abdominal examination findings could be unreliable in early trauma   assessment. This case highlights the importance of early identification of bleeding at retroperitoneal space in patients with hemorrhagic shock and negative FAST.  

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Keywords

isolated adrenal haemorrhage, blunt abdominal trauma, retroperitoneal haematoma

References
Y.-H. Lin, T. Wu. Isolated adrenal hemorrhage after blunt trauma: Case report and literature review. Urological Science 24 (2013) 27-29
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Lee, Y.S., Jeong, J.J., Nam, KH. et al. Adrenal Injury Following Blunt Abdominal Trauma. World J Surg (2010) 34: 1971. https://doi.org/10.1007/s00268-010-0537-x
Igwilo OC, Sulkowski RJ, Shah MR, Messink WF, Kinnas NC. Embolization of traumatic adrenal hemorrhage. J Trauma 1999;47:1153e5.
Francque, Sven M.a; Schwagten, Veerle M et. El. Bilateral adrenal haemorrhage and acute adrenal insufficiency in a blunt abdominal trauma: a case-report and literature review. European Journal of Emergency Medicine: June 2004 - Volume 11 - Issue 3 - p 164-167.
Section
EMAS Meeting 2018 Abtracts