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

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

A Morel-Lavallée lesion is a rare internal degloving injury that patients present with to the Emergency Department (ED) typically following high impact trauma. The diagnosis is often missed due to its uncommon presentation and emphasis on other concomitant injuries that may have occurred as a result of polytrauma. Potential long-term complications from these closed soft-tissue injuries highlight the need for early recognition. We present one such case encountered in our ED and aim to familiarize readers with the presentation, diagnostic and treatment modalities, and challenges emergency physicians might face when encountering patients with such lesions.

Rare Constellation of Pelvic Injuries: A Case Report

Crescent fracture-dislocations are sunset of lateral compression injuries. They can be associated with vascular, bowel, genitourinary, or soft tissue degloving injuries. Here, we describe a patient with bilateral crescent fracture-dislocation, right common iliac artery (CIA) injury, and an extensive Morel-Lavallée lesion (MLL). A 35-year-old male was transferred to our hospital after being involved in a motor vehicle collision with an unknown mechanism. Upon evaluation, four rare injuries were found: right CIA injury, bilateral open iliac bone fracture, bilateral crescent fracture-dislocation, and an extensive MLL. The patient underwent successful right CIA thrombectomy and stenting, followed by irrigation and debridement of MLL and open pelvic fractures. However, his hospital course was complicated by septic shock with spontaneous rectal perforation, necessitating massive transfusion protocol activation and three relook laparotomies. Unfortunately, the patient died after 25 days of a turbulent hospital course. The combination of bilateral crescent fracture-dislocation, bilateral open pelvic fracture, CIA injury, and an extensive MLL is exceedingly rare. Each poses a challenge when encountered alone, nevertheless, after establishing hemodynamic stability, timely intervention is crucial to avoid possible morbidity and mortality.