MOREL- LAVALLÉE LESION: AN ELUSIVE COUNTER

Abstract

Introduction:

Morel-Lavallée lesion (MLL) is a closed degloving injury of the soft tissue that occurs deep in the subcutaneous plane related to high-energy trauma. This is an elusive diagnosis and can leads to devastating consequences. Herein, we share a case of a young man presented to us post trauma and succumbed due to undiagnosed MLL.

Case report:

A 31-year-old morbidly obese man presented with left upper thigh and left flank pain for 4 days. He was involved in a motor-vehicle-accident 2weeks ago where his motorbike skidded, landing on his left side. The pain worsened causing him unable to ambulate. On examination, he was alert and his vital signs were normal. His abdomen was soft, small bruises and tender on the left flank. Focused Assessment with Sonography in Trauma (FAST) was negative. A provisional diagnosis of soft tissue injury was made then.

Unfortunately, the patient deteriorated and succumb to death after 20 hours of hospitalization. Post-mortem revealed extensive subcutaneous hemorrhage at left anterolateral wall of abdomen consequence to blunt force injury.

Discussion:

MLL is often delayed or misdiagnosed up to 30% due to delayed presentation or presence of distracting injuries in a trauma patient. MLL most commonly occur near the greater trochanter (30.4%), However, can still be found at other parts of the body; our patient’s lesion was at the abdomen which the incidence is only 1.4% 2.

MLL may present immediately or may appear days after injury. This occurrence can be attributed to the extent and rate of hemolymphatic accumulation in the dead space and the patient’s body habitus. Our patient was obese with BMI > 25 and presented to us after 2 weeks of trauma. 

The most important clinical significance in this case demonstrates that the knowledge of MLL among medical practitioners is limited with most unable to recognize it. However, its undesired consequences such as infections, pain, extensive tissue necrosis and even death can result if failure to recognize it and intervene timely.

Conclusion :

MLL is an uncommon entity but can lead to devastating consequences. Awareness among the frontliners should be built in order to save life.