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Loeffert, J.

Silvis, M.

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Acute	  Abdominal	  Injury	  in	  a	  Collegiate	  Hockey	  Player	  Jayson	  R	  Loeffert	  DO,	  Pennsylvania	  State	  University	  	  Primary	  Care	  Sports	  Medicine	  Fellowship-­‐Hershey	  	  Sponsors:	  	  Matthew	  Silvis	  MD,	  Cayce	  Onks	  DO,	  Shawn	  Phillips	  MD	  	  HISTORY:	  19yo	  male,	  collegiate	  ice	  hockey	  player,	  suffered	  an	  abdominal	  injury	  in	  a	  game.	  Hit	  into	  the	  boards	  by	  another	  player.	  	  This	  occurred	  at	  his	  team’s	  bench,	  and	  he	  had	  to	  be	  helped	  over	  the	  boards.	  	  He	  was	  then	  moved	  to	  the	  locker	  room	  for	  evaluation.	  	  He	  was	  pale,	  diaphoretic,	  and	  complained	  of	  acute	  left	  upper	  quadrant	  pain.	  	  Pain	  was	  7/10,	  sharp,	  radiating	  to	  his	  left	  shoulder.	  	  He	  was	  transferred	  to	  the	  local	  ED	  for	  further	  evaluation,	  due	  to	  concern	  for	  intra-­‐abdominal	  trauma.	  PHYSICAL	  EXAMINATION:	  Vital	  Sign:	  Pulse	  74-­‐84,	  BP	  92-­‐137/	  51-­‐68,	  RR	  18-­‐20,	  PO2	  100#	  General:	  	  awake,	  alert,	  NAD	  HEENT:	  	  head	  and	  facial	  bones	  nontender,	  EOMI,	  PERRLA,	  TM	  intact	  without	  fluid/blood,	  no	  blood	  in	  mouth/nares,	  mucous	  membranes	  moist	  	  	  Neck:	  	  nontender,	  no	  stepoffs/crepitus,	  trachea	  midline	  	  	  Heart:	  	  regular	  rate	  and	  rhythm,	  no	  murmurs	  	  	  Lungs:	  	  clear	  bilaterally,	  chest	  wall	  nontender,	  no	  wheezing/rales	  	  	  Abdomen:	  	  soft,	  tender	  to	  palpation	  at	  left	  upper	  quadrant,	  nondistended,	  +BS,	  	  no	  guarding,	  or	  rigidity.	  	  Extremities:	  	  pulse/motor/sensory	  grossly	  intact	  	  	  Neuro:	  	  alert/oriented,	  no	  focal	  deficits,	  CN	  2-­‐12	  intact	  	  	  Skin:	  	  no	  rashes/erythema/ecchymosis	  over	  abdomen	  	  	  DIFFERENTIAL	  DIAGNOSIS:	  Splenic	  laceration/	  contusion	  Abdominal	  wall	  strain	  Bowel	  rupture	  Injury	  to	  pancreas	  Injury	  to	  stomach	  Rib	  Fracture,	  contusion	  	  TESTS	  AND	  RESULTS:	  CBC,	  CMP,	  and	  Lipase	  normal.	  	  CT	  chest/abdomen	  -­‐	  Small	  sub	  centimeter	  splenic	  contusion	  involving	  the	  lower	  pole.	  No	  other	  traumatic	  injury	  identified.	  Thickening	  of	  the	  bowel,	  appreciated	  by	  general	  surgery,	  questionable	  significance,	  concerning	  for	  possible	  laceration.	  	  FINAL/WORKING	  DIAGNOSIS:	  Small	  bowel	  laceration	  	  TREATMENT	  AND	  OUTCOME:	  Following	  initial	  studies	  and	  evaluation,	  he	  was	  observed	  overnight,	  due	  to	  pain	  and	  possible	  spleen	  injury.	  	  Overnight,	  pt	  was	  seen	  to	  have	  increased	  heart	  rate,	  pain,	  and	  WBC.	  	  He	  was	  taken	  for	  exploratory	  laparotomy	  which	  revealed	  a	  small	  bowel	  perforation.	  	  This	  was	  surgically	  repaired.	  	  No	  other	  injury,	  including	  that	  to	  the	  spleen,	  could	  be	  appreciated.	  	  Pt	  remained	  in	  the	  hospital	  for	  6	  days,	  which	  were	  uneventful,	  then	  discharged	  home.	  	  One	  month	  later,	  he	  was	  seen	  in	  follow	  up	  by	  trauma.	  	  His	  exam	  was	  unremarkable.	  	  He	  was	  held	  from	  hockey	  for	  the	  remainder	  of	  the	  season.	  He	  was	  otherwise	  released	  to	  full	  activity	  and	  cleared	  to	  participate	  in	  next	  year’s	  hockey	  season.	  	  

Acute Abdominal Injury in a Collegiate Hockey Player

http://digitalcommons.wku.edu/cgi/viewcontent.cgi?article=2853&context=ijesab

Acute Abdominal Injury in a Collegiate Hockey Player

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