Major trauma : from the grand surgical rounds: a presentation in the Makerere University Medical School Davies Lecture Theatre; August 1st 1996

ABSTRACT

A case was presented of a 60 year old male patient from Mubende who had met with the bonnet of a fast moving vehicle and sustained injuries to both lower limbs (with an open fracture of the right tibia). Primary suture of the pretibial laceration had been done. On the second day; he had been found to be tender in the epigastrium; and there was some swelling and pain under the rib margin on the left; so; with a diagnosis of rupture of the spleen; he was referred from Mityana Hospital to Mulago; after emergency splinting of the lower limb. At Mulago; he was found to be dehydrated; apyrexial; with a rapid pulse but a normal blood pressure. The wound just above the right ankle was dirty with a crusting of blood over it. His abdomen was distended; with guarding; dullness and tenderness in the left hypochndrium. Accordingly; he was diagnosed as having a ruptured spleen; and the injured organ was removed totally as he had an accessory spleen; so splenic conservation was not indicated. He made a reasonably straightforward post-operative recovery apart from an infection of the right tibial fracture. The article includes highlights on pathophysiology; complications; prognostic factors and lessons which include the danger of missing a rupture of an internal organ when there is an obvius fracture; and the danger of doing immediate primary suture of a tibial fracture in a case with multiple injuries