Morel-Lavallée lesion as an unusual cause of hemorrhagic shock: Case report and review of literature

Abstract

Introduction Morel-Lavallée syndrome (MLS) is considered as a rare entity and hemorrhagic shock as a complication is uncommon. Presentation of case We report the case of a 56-year- old man who presented to the emergency department after a road traffic accident. Initially, the patient was hemodynamically unstable (heart rate 160 beats/min and blood pressure 65/30). Physical examination revealed multiple lacerations on his back and a gradually expanding large subcutaneous hematoma on the left flank extending to the hip and left leg. Fluid resuscitation was rapidly initiated. After stabilizing his hemodynamic status, a full-body computed tomography was performed revealing, apart from a small unilateral pneumothorax and a stable pelvis fracture, an extensive Morel-Lavallée lesion in the lumbar region extending to the hip and both legs. The patient was then transferred to a surgical intensive care unit for further resuscitation and surgical drainage of the collection followed by continuous suction was performed. Even though rare, Hemorrhagic shock is one of the threatening complications of Morel-Lavallée lesions and should be kept in mind by every traumatologist and emergency doctor. Conclusion We report a case about a rare complication of MLS which is hemorrhagic shock in order to highlight the importance of making the diagnosis, which can be unrecognized, and initiate an adequate treatment on time.

What lies beneath: A case report of Morel-Lavallée lesion

“…1 Interestingly, there have been two case reports of MLLs that have presented to the ED as hypovolemic shock. 12,13 In chronic ML lesions, patient may present with gradually increasing swelling with or without pain and no obvious overlying dermal injury from the initial event. 2,3,7 Diagnostic imaging is key in the confirmation of suspected MLLs.…”

Rare Constellation of Pelvic Injuries: A Case Report

“…A review of the literature failed to find a similar report of such extent. However, Daghmouri et al reported a case of extensive MLL involving the lumbar spine and lower limbs, which complicated the patient’s condition and resulted in hemorrhagic shock [ 8 ]. Gummalla et al also reported a case of extensive MLL which was missed on initial evaluation in a patient with a wrist fracture and abrasions over the trochanteric region.…”

Soft tissue compartment bleed—the iceberg phenomenon: a case report

“…• In the absence of a specific guideline/protocol for the management of soft tissue compartment bleeding, treatment should be individualized based on the hemodynamic status of the patient. Hefny et al [6] Extensive hematoma between the subcutaneous fat and the paraspinal muscles in the back Percutaneous suction drain Discharged Yumoto et al [7] Large hematoma in the lower back with lumbar vertebrae fractures with active contrast extravasation at multiple sites located close to the bilateral lumbar and internal iliac arteries Gel foam embolization Discharged Mao et al [8] Left flank to thigh NOM but later required open drainage for infected collection Discharged Claassen et al [9] Lower lumbar region in the back NOM Discharged Daghmouri et al [10] Lumbar region extending to hips and both legs Surgical drainage Discharged NOM, nonoperative management.…”