Page 11 - Journal of Special Operations Medicine - Fall 2014

Figure 3 Case 3: small hematoma in the left pelvis at the Figure 4 Case 4: small hematoma interposed between the
level of the iliac vein. rectus abdominis muscles and bladder.

breathing room air. The physical exam revealed tender-
ness over the right gluteal area and the right anterior su-
perior iliac spine. The patient’s initial labs were normal,
negative, and his surgical history was positive for re- and a bedside FAST exam was found to be negative.
mote removal of a left-sided nephrolith. His family his- Radiographs of the pelvis were negative for fractures
tory was negative and his immunizations were current. or joint space abnormality. CT scan of the abdomen
His review of systems was positive for suprapubic, lower and pelvis showed a small 2cm anterior left abdomi-
back, and pelvic pain. nal wall hematoma (Figure 5) within the bony pelvis.
Based on the paucity of adverse findings, the patient was
His vital signs on presentation were temperature 97.8ºF, discharged home with oral pain medications and bed
pulse rate 86/min, blood pressure 141/81mmHg, res- rest with the diagnosis of hip and buttock pain. This
piration rate 16/min, and oxygen saturation 100% patient returned to the ED 3 days later with continued
breathing room air. The patient’s exam was remarkable complaint of pelvic pain. His hematocrit had dropped
for tenderness to palpation over the lumbar region and, 11.8% from his initial ED visit. CT scan of the pelvis
more significantly, pain expressed over the suprapubic showed an interval increase of the left pelvic hematoma
area. Radiographs of the pelvis were negative for frac- with findings suggestive of mass effect on the left side of
tures or any joint space abnormality. CT scan of the the bladder. This patient was admitted to our facility’s
pelvis showed a small hematoma between the inferior step-down unit with the surgery service, transfused with
aspect of the rectus abdominis muscles and bladder blood products (Table 1) and discharged 4 days later
(Figure 4). The patient was transferred to an outside after close observation.
medical treatment facility with the capability to perform
interventional angiography. He was admitted to the Figure 5 Case 5: small hematoma posterior to the anterior
ICU at that facility and discharged after 1 day of close abdominal wall anterior to the bladder.
observation.

Case 5
A 27-year-old male Soldier presented to the ED brought
in via a military field litter ambulance with a chief
complaint of right hip pain after a military static-line
parachute jump. On arrival, the patient was in severe
discomfort with pain rated as 8/10. His position of com-
fort was lying recumbent on his left side. The patient
had no allergies and no significant past medical or surgi-
cal history. His immunizations were current. His review
of systems was positive for left hip pain.

The patient’s vital signs on presentation were temperature
97ºF, pulse rate 78/min, blood pressure 137/83mmHg,
respiration rate 18/min, and oxygen saturation 99%

Traumatic Pelvic Hematoma After a Parachute Jump 3