William Santis, MD
Douglas Dahl, MD
Michelle M. McNichols, MD
Brian Saltzman, MD
Beth Israel Hospital
Harvard Medical School
Boston, MA

A twenty-six year old man presented to the emergency room following a high speed motor vehicle accident. He sustained multiple orthopedic injuries and a liver laceration which was identified by spiral abdominal CT (Figure 1), but never had an episode of hypotension. He underwent fixation of his orthopedic injuries during the first several days of his hospitalization and appeared to be doing well. On hospital day eight, he developed abdominal pain and distention, with fever to 102°F. He was imaged by repeat abdominal CT (Figure 2).

PMH/PSH: None

Medications: None

Physical Examination: Remarkable for a tense, tender abdomen with gurarding and absent bowel sounds. There was no evidence of costo-vertebral angle tenderness.

Laboratory Values: Urinalysis on admission : 10 RBC, no WBC.

Figure 1



Initial Abdominal CT

Figure 2



Follow up Abdominal CT

DIAGNOSIS and DISCUSSION

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