Abstract
BACKGROUND
Abdominal injury caused by blunt trauma is a common presentation in the emergency room. Especially in developing countries like Indonesia, the number of motor vehicle accident in public roads is still high. Eighty percentages of traumatic injury are blunt injury with the majority of deaths which are caused by hypovolemic shock.
CASE DESCRIPTION
A 43-year-old man arrived at the emergency room after motorcycle accident 2 h before. AMPLE and primary survey was conducted: clear airway, spontaneous breathing, BP 70/palpation mmHg, HR 123 times/min, and altered consciousness, in which showed the patient was undergoing hemorrhagic shock. The patient was hemodynamically stable after being given 1 L of normal saline through two intravenous lines. FAST was conducted and intraperitoneal free fluid was seen in Morison’s pouch, left hemithorax, and pouch of Douglass. Chest X-ray showed fracture of ribs 7, 8, and 9 left lateral aspect with minimal hemothorax. After a supporting examination was performed, the patient’s BP dropped to 60/40 mmHg, showing the patient was a “transient responder,” indicating the patient should undergo laparotomy. The patient was given 500 mL colloid with a systolic target of 80–90 mmHg in accordance to permissive hypotension theory ± 1500 mL blood was found inside the abdomen during operation, a splenic rupture grade V was the cause. In the 5th day after surgery, the patient was discharged.
CONCLUSION
Since blunt abdominal trauma could cause intraperitoneal bleeding that leads to hemorrhagic shock; therefore, immediate diagnosis is needed. Multiple trauma management at rural hospital should be concordant to ATLS and Schwartz’s Principles of Surgery.