Sound Bite 9 - Traumatic Heamoperitoneum (Paeds)

Author: Dr Nick Mani

14yr old child presents to the local Emergency Department with a handle-bar injury to the lower abdomen. On examination, there is a bit of redness and tenderness to the lower abdomen, but no peritonism. No other signs of injuries detected.

You elect to perform FAST, the pelvis view as shown below:

Clip- Longitudinal axis view of the pelvis, anechoic free fluid above the bladder and just below the bowel (transverse axis did NOT rule in free fluid- not shown)

The POCUS finding in the context of the mechanism of injury and standard clinical assessment is more likely to be due to traumatic small bowel injury. Urgent trauma CT abdomen/pelvis was performed, which demonstrated fat stranding of the small intestine associated with a pocked of free fluid.

Case Resolution

The local general surgeons were consulted who reviewed the child and urgently arranged a transfer to the tertiary children's hospital for ongoing assessment and care.

Take Home Message:

Handlebar injuries in children are not uncommon and a dangerous mechanism leading to serious injuries. POCUS-enhanced clinical assessment/FAST (2x views for pelvis is important) may still have a role to rule-in free fluid (and help with urgent CT request, surgical review, facilitate transfer). Have a very low threshold for CT scan even in negative FAST.