Multi visceral and hand injury after an explosion of a home-made explosive presenting with massive haemorrhage shock – A case report from UMC Ljubljana

Abstract text (incl. references and figure legends)

A 17-year-old patient was transported to the emergency department of the UMC Ljubljana by helicopter after a home-made explosive device exploded in his hands.He presented with a periumbilical wound with protrusion of the small bowel, amputation of several fingers of the left hand and several wounds on the chest and arms. He was oriented and talkative, GCS was 14. His first vitals at the ED were blood pressure of 95/65 mmHg, pulse 130 bpm and body temperature of 34,9°C. Pulse O2 saturation couldn"t be measured. He complained of severe abdominal pain. FAST showed signs of free intraperitoneal fluid. X-rays of the pelvis and chest did not show any pathologies. A working diagnosis of a massive intraabdominal bleeding was made.He was urgently intubated, a central venous line was inserted and a protocol of massive transfusion was started.He was haemodynamically unstable, despite aggressive fluid resuscitation and vasoactive support, so prompt explorative laparotomy by an abdominal surgeon was made. One of the shrapnel transected the inferior vena cava, which was sutured by a cardiovascular surgeon. Pancreas was also completely divided by a shrapnel at the site of the pancreatic neck with subsequent injuries to the duodenum and a complete avulsion of choledochal duct, therefore a cephalic pancreaticoduodenectomy was performed. Multiple injuries to the stomach, small bowel, colon and a smaller laceration of the liver were also found. Simultaneously plastic surgeon operated on both hands, also performing functional reconstruction of left thumb remnant and palm defect coverage. Altogether he received 26 units of CE, 21 units of FFP and 24 units of thrombocytes until haemodynamic stabilisation. Postoperative CT scans of head, neck, chest and abdomen were made and showed no other important injuries.He was firstly admitted to level 1 ICU unit from which he was discharged after two days. He spent another 27 days at the ward. He was then transferred to a rehabilitation Institute.

Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.)

NO