Traumatic Adrenal Hemorrhage Masking as a Pseudotumor.

Several case reports have been filed regarding the latent presentation of hemorrhagic pheochromocytomas in the trauma setting; however, few patients have been found to exhibit these symptoms in the absence of a tumor. In this report, we discuss a patient who sustained blunt abdominal trauma leading to the development of an adrenal hemorrhage and his unexpected sequelae of symptoms. Discovery of the source of the patient's symptoms was delayed secondary to multiple comorbidities in the critical care setting and work-up for other sources such as infection and agitation. Hypertensive urgency was confirmed to be of adrenal etiology with measurement of persistently elevated plasma and urine metanephrines during the hospital course. The patients hypertensive urgency was successfully managed with the use of antisympathomimetics including an esmolol drip, clonidine, and eventually tapered dose of metoprolol. Symptoms improved over time, and repeat CT imaging weeks later showed resolution of the hematoma. Review of literature reveals only one other case of adrenal hemorrhage after blunt force trauma resulting in hemorrhagic psuedotumor. To our knowledge, this is the second such case ever presented. This case is discussed along with the presentation, diagnostic work-up, and treatment of a critically ill patient with an adrenal hemorrhage masked as a pseudotumor.

Delayed Small Bowel Perforation in a Pre-Existing Ventral Hernia After Blunt Trauma.

A hollow viscus injury is an uncommon but potentially dangerous intra-abdominal injury that can result from blunt abdominal trauma. It can be misdiagnosed in patient, particularly when the patient has other concerning findings. Also, diagnosis can be increasingly difficult in a patient with a pre-existing ventral hernia and chronic abdominal pain. In this case we present a 66-year-old women, with a history of a large ventral hernia and chronic abdominal pain, who presented to the emergency department after a motor vehicle crash (MVC). Patient denied abdominal tenderness at the time of presentation and the initial computed tomography (CT) did not demonstrate any abnormal findings within the abdomen. Patient later began experiencing increased abdominal pain and presented with a small bowel perforation within the hernia that required a bowel resection and hernia repair.  A review of the literature reveals that not only are hollow viscus injuries rare but there appears to be few documented cases of viscus injuries occurring within a existing ventral hernia.