Morel-Lavallee Lesion of the Lower Back Mimicking an Abscess: A Case Report

Abstract

A closed degloving injury, or Morel-Lavallee lesion, is the result of a severe, traumatic, shearing injury, causing separation of the skin and subcutaneous tissue from the underlying deep fascia. Though well described in the orthopedic trauma literature, this lesion is not well recognized by the general surgeon in the poly-trauma setting. We present a case of a 41 year old man who was referred to the general surgery service for a "back abscess". Upon patient interview, history of a recent motor vehicle collision (MVC) was obtained, including a pelvic fracture. Imaging demonstrated a large Morel-Lavellee lesion extending from the pelvis into the lower back. Knowledge of this entity is crucial to avoid unnecessary procedures in the management of these patients.

Morel-Lavallée Lesion: A Case Report of a Large Post-Traumatic Subcutaneous Lumbar Hematoma and Literature Review

“…Our patient had distinctive fluctuant swelling and contusion over the area of degloving. MLL could be isolated or associated with underlying skeletal injuries [24] [33]. In our case, there was no skeletal lesion associated with the degloving injury.…”

“…High-velocity trauma such as road traffic accidents are the most common causes of MLL, but low kinetic crush injuries occurring during sports activities may also result to MLL [4] [27]. Cases of MLL associated with skeletal injuries have been reported [24]. Our patient was fortunate enough to have not sustained skeletal injuries, despite being involved in a high kinetic trauma.…”

“…MLL have been described in males and females alike, indiscriminative of age [5] [7] [8] [20]. Some authors argue that cases of female MLL are significantly higher compared with male ones given the pattern of fat distribution in female [24] [25]. and anatomical and molecular basis of fasciae [26].…”

Resultados do tratamento cirúrgico da lesão de Morel‐Lavallée. Estudo coorte prospectivo

“…Contudo, não há evidências de que esse tratamento seja isento de sequelas. 10,11,16 Algumas lesões podem persistir, a despeito dos tratamentos convencionais. Nesses casos, são comumente indicados métodos mais agressivos, como a aspiração seriada e o uso de esclerose química, em casos de formação de pseudocistos.…”

“…9,10 O espaço criado é preenchido por sangue, linfa ou tecido gorduroso necrótico, que, não raro, leva a processos inflamatórios e infecciosos graves. 3,[7][8][9][10] O diagnóstico da LML não é tarefa fácil. Na grande maioria das vezes são traumas fechados, o que, não raro, causa confusão ou mesmo ausência de diagnóstico.…”