Nonoperative treatment of a blunt adrenal gland trauma with blush: A case report

Abstract

Adrenal gland trauma is a rare and scarcely reported injury due to its retroperitoneal position and relationship with adjacent tissues. We report a male patient with a history of a thoracoabdominal blunt trauma with adrenal injury as an isolated abdominal viscera. He was hemodynamically stable at admission, with a blush within his adrenal hematoma. The patient was treated nonoperatively and subsequently discharged after 15 days. The available literature reports advantages of a nonoperative approach compared to surgery, which is necessary in only 1% of cases that are predominantly polytrauma patients with multiple intra-abdominal injuries. Therefore, a nonoperative treatment is recommended for patients with an isolated adrenal gland injury who are hemodynamically stable during hospital stay.

Keywords: Abdomen; Adrenal gland; Management; Non operative; Trauma.

Fig. 1

CT image at admission showing a 110 × 90 mm hematoma in the upper portion of the right perirenal fat compressing the kidney and right hepatic lobe (arrow), with signs of contrast extravasation due to active bleeding associated with a small amount of liquid/hematic perihepatic content in the anterior and posterior peri- and pararenal fat and right paracolic gutter.

Fig. 2

Control CT image showing a massive right adrenal hematoma measuring 11.7 × 9.8 cm in the largest axis (arrow). Small right perirenal hematoma measuring 1.2 cm in maximum thickness with obliteration of the perirenal fat and thickening of the pararenal fasciae is seen. The right adrenal hematoma was slightly increased. No active bleeding areas were identified in the present analysis with the evaluation protocol used.