A 35-year-old man is involved in a high-speed motor-vehicle collision. He is hemodynamically unstable and has pronounced flank ecchymosis (Grey Turner sign). Which retroperitoneal injury is most likely responsible for his presentation?
Kidney injury
Abdominal aortic injury
Duodenal injury
Pancreatic injury
Flank ecchymosis, or Grey Turner sign, signifies retroperitoneal hemorrhage. In blunt abdominal trauma, the kidneys are the most frequently injured retroperitoneal organs. Their vascularity and exposure to deceleration forces make renal lacerations and perirenal hematomas common causes of bleeding that can track to the flanks. Although abdominal aortic, pancreatic, and duodenal injuries can also bleed retroperitoneally, they occur far less often after blunt trauma and usually present with other distinguishing features (e.g., pulse deficits with aortic injury, elevated lipase with pancreatic injury). Therefore, kidney injury is the most likely diagnosis.
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