Paintball-related traumatic liver injury

Abstract

Paintball is a popular recreational sport played at both amateur and professional level. Ocular injuries are well recognised, although there is a growing body of literature documenting superficial vascular as well as deep solid organ injuries. An 18-year-old man presented with signs and symptoms consistent with acute appendicitis. Intraoperatively, a grade III liver injury was identified and packed before a relook at 48 h. No further active bleeding was identified; however, follow-up ultrasound at 3 weeks demonstrated non-resolution of a large subcapsular haematoma. The patient was readmitted for a short period of observation and discharged with repeat ultrasound scheduled for 3 months. This represents the first report of paintball-related blunt traumatic injury to the liver. Solid organ injuries of this nature have only been reported three times previously-all in the urological setting. This case also highlights issues surrounding the use of routine follow-up imaging in blunt liver trauma and provides a concise discussion of the relevant literature.

Figure 1

Postoperative CT (axial slice): large liver haematoma visible with areas of clot formation. Mild streaking artefact secondary to patient's arm position.

Figure 2

Postoperative CT (coronal slice): infrahepatic radiolucency represents surgical packs later removed at re-look laparotomy.

Figure 3

Delayed CT (3 weeks postinjury): persistent large subcapsular haematoma (measuring 13.5 cm×10.1 cm×16.5 cm).