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JAMA Surgery Clinical Challenge
March 1, 2017

Multiple Injuries in Blunt Abdominal Trauma

Author Affiliations
  • 1Department of Surgery, Providence Hospital and Medical Centers, Southfield, Michigan
  • 2Department of Surgery, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
  • 3Department of Cardiothoracic Surgery, Detroit Medical Center, Sinai Grace Hospital, Detroit, Michigan
JAMA Surg. Published online March 1, 2017. doi:10.1001/jamasurg.2017.0019

A 24-year-old man was brought to the emergency department after a high-speed motor vehicle collision. He was a restrained driver noted to be awake at the scene of the collision and had to be extracted from the vehicle. He was hemodynamically stable on route to the hospital. In the emergency department, the patient was awake but restless and combative and was subsequently intubated. He was hypotensive on arrival but responded transiently to fluid resuscitation. Multiple closed long bone fractures of the upper and lower extremities were noted. The chest radiography (Figure 1A) showed marked elevation of the left hemidiaphragm. The pelvic radiography revealed an unstable fracture involving bilateral pubic rami and the left sacroiliac joint. The pelvis was splinted in the emergency department. He remained transiently responsive to fluid resuscitation and was taken for emergent computed tomography. Computed tomography of the head and cervical spine showed no evidence of injury. A computed tomographic scan of the chest (Figure 1B) and abdomen was then performed, and the patient was taken to the operating room.

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