MSS01: PERIVESICULAR HEMATOMA: A UNIQUE INJURY RESULTING FROM MILITARY PARACHUTING
Elizabeth Andersen, MD; Alec Donohue, DO; Ilya Latyshenko, MD; Trey Nettles, MD; Thatcher Shepard, MD; Jennifer Carney, RN; Rowan Sheldon, MD; Shaun Brown, DO; Womack Army Medical Center
Objective: Perivesicular hematomas (PVH) are an uncommon injury resulting from Airborne operations. While often treated like retroperitoneal hematomas, little is known about the morbidity and severity of this unique finding. We sought to identify and characterize this injury pattern to assist providers in the appropriate triage and disposition of injured soldiers.
Methods: Eleven ICD codes associated with parachuting-related injuries were cross-referenced with local hospital records from January 2016 through December 2020. Patients were queried for abdomen and pelvis computed tomography (CT) within 30 days of the identified Airborne operation. Films were retrospectively evaluated by two independent practitioners for PVH. Patients found to have PVH underwent chart review for presenting symptoms, vitals, ultrasound, hematoma volume, length of stay, and procedural intervention. Pearson’s correlation coefficients were used to determine correlation between PVH volume and change in hemoglobin as well as PVH volume and length of stay (LOS).
Results: Perivesicular hematoma was identified in 13 of 1,307 (1.0%) patients injured during Airborne operations. Every patient presented after a hard landing on their side, with pelvic pain and difficulty weight bearing on the injured side. Average heart rate was normocardic, one patient (7.7%) was tachycardic at 104 bpm. All patients were normotensive. Three patients (23.1%) underwent focused assessment with sonography for trauma. All were nondiagnostic. Initial hemoglobin averaged 14.3 ±1.1 g/dL (range 12.6-16.0). 9 of 13 patients (69.2%) had repeat testing. All had decreased hemoglobin (2.6 ±1.5 g/dL). PVH Volume averaged 317.6 ±355.8 mL3 and positively associated with change in hemoglobin (R=0.65, p=0.01). Eight of thirteen (61.5%) patients were admitted for observation. Three patients had active extravasation on CT. All patients remained hemodynamically stable and underwent repeat imaging. Only one patient had persistent extravasation and underwent hypogastric angioembolization. Hospital length of stay (LOS) averaged 2.5 ±1.3 days. LOS positively correlated with increasing PVH volume.
Conclusion: Perivesicular hematoma is a rare but unique injury from military parachuting. PVH volume correlates with a decrease in hemoglobin and appears to impact decision-making on hospital LOS. Observation periods for PVH after military parachuting incidents can likely be shortened in the absence of active extravasation. Additional research will be required to better guide return to work timing and appropriate precautions.
The views expressed herein are those of the author(s) and do not necessarily reflect the official policy of the Department of the Army, Defense Health Agency, Department of Defense, or the U.S. Government.